Ex-Post : The Investment Performance of Collectible Stamps

NARCIS (Netherlands)

Dimson, E.; Spaenjers, C.

2009-01-01

This paper investigates the returns on British collectible postage stamps over the very long run, based on stamp catalogue prices. Between 1900 and 2008, we find an annualized return on stamps of 6.7% in nominal terms, which is equivalent to an average real return of 2.7% per annum. Prices have

Tribological Behavior of Laser Textured Hot Stamping Dies

Directory of Open Access Journals (Sweden)

Andre Shihomatsu

2016-01-01

Full Text Available Hot stamping of high strength steels has been continuously developed in the automotive industry to improve mechanical properties and surface quality of stamped components. One of the main challenges faced by researchers and technicians is to improve stamping dies lifetime by reducing the wear caused by high pressures and temperatures present during the process. This paper analyzes the laser texturing of hot stamping dies and discusses how different surfaces textures influence the lubrication and wear mechanisms. To this purpose, experimental tests and numerical simulation were carried out to define the die region to be texturized and to characterize the textured surface topography before and after hot stamping tests with a 3D surface profilometer and scanning electron microscopy. Results showed that laser texturing influences the lubrication at the interface die-hot sheet and improves die lifetime. In this work, the best texture presented dimples with the highest diameter, depth, and spacing, with the surface topography and dimples morphology practically preserved after the hot stamping tests.

The effect of cushion-ram pulsation on hot stamping

Science.gov (United States)

Landgrebe, Dirk; Rautenstrauch, Anja; Kunke, Andreas; Polster, Stefan; Kriechenbauer, Sebastian; Mauermann, Reinhard

2016-10-01

Hot stamping is an important technology for manufacturing high-strength components. This technology offers the possibility to achieve significant weight reductions. In this study, cushion-ram pulsation (CRP), a new technology for hot stamping on servo-screw presses, was investigated and applied for hot stamping. Compared to a conventional process, the tests yielded a significantly higher drawing depth. In this paper, the CRP technology and the first test results with hot stamping were described in comparison to the conventional process.

The cost of Medicaid annuities.

Science.gov (United States)

Levy, Robert A; Nyman, John A; Gabay, Mary; Riley, William; Feldman, Roger

2006-01-01

Medicaid annuities are annuities that long-term care recipients use to shelter assets, thereby qualifying them early for Medicaid eligibility. As such, these annuities have the potential to increase Medicaid costs. This study estimates the cost of annuities to the Medicaid program. From a sample of Medicaid applications in five states, we found the rate at which annuities were used and simulated their cost to Medicaid. We estimated that in 2004, Medicaid annuities cost Medicaid about 197 million dollars, which represented a small proportion of Medicaid's almost 50 billion dollars cost for nursing home care.

27 CFR 479.87 - Cancellation of stamp.

Science.gov (United States)

2010-04-01

... OTHER FIREARMS Transfer Tax Application and Order for Transfer of Firearm § 479.87 Cancellation of stamp. The method of cancellation of the stamp required by this subpart as prescribed in § 479.67 shall be used. Exemptions Relating to Transfers of Firearms ...

Influence of Prepreg Characteristics on Stamp Consolidation

NARCIS (Netherlands)

Slange, T.K.; Warnet, L.L.; Grouve, W.J.B.; Akkerman, R.

2017-01-01

Stamp forming is a rapid manufacturing technology used to shape flat blanks of thermoplastic composite material into three-dimensional components. The development of automated lay-up technologies further extends the applicability of stamp forming by allowing rapid lay-up of tailored blanks and

Analysis of alternative technologies stamping compressor blades of marine engines

Directory of Open Access Journals (Sweden)

Олександр Сергійович Аніщенко

2015-10-01

Full Text Available The author has made an analysis of several technologies stamping forgings compressor blades from titanium alloy ВT3-1. These technologies use different types of forming equipment: crank hot press, high-speed hammers, screw presses with hydraulic drive (SPHD, as well as isothermal forging hydraulic press. He pointed out the main advantages and disadvantages of the technology, noting that high-speed punching in the shipbuilding industry of Ukraine is not used for the manufacture of forgings blades. The article contains an economic analysis of the cost of forgings blades, which are made on four technologies: punching and calibration to crank hot press, stamping and calibration to press for isothermal forging, stamping and calibration on SPHD-press, stamping on SPHD-press and calibration to press for isothermal forging. The author has identified the effective use of these technologies. He showed that the use of SPHD-presses and hydraulic presses for isothermal forging reduces the cost of forging on the average 12% in comparison with the technology at the crank hot stamping press, increases the utilization of metal 1,3-1,5 times more, reduces power consumption 1,05-3,0 times less and complexity of manufacturing 1,8-4,2 times. However SPHD-press increases capital investment in the organization of stamping technology 2,6-5,3 times more and depreciation 2-4 times. Isothermal forging technology requires the cost of the stamps in 1,4-2,0 times higher than stamps for crank presses. The author argues that stamping forging blades technology improvement should be implemented saving basic materials first of all. Efficiency of isothermal stamping and calibration will be the higher, the more geometric dimensions of stamped forgings are

Medicaid Participation among Liver Transplant Candidates after the Affordable Care Act Medicaid Expansion.

Science.gov (United States)

Tumin, Dmitry; Beal, Eliza W; Mumtaz, Khalid; Hayes, Don; Tobias, Joseph D; Pawlik, Timothy M; Washburn, W Kenneth; Black, Sylvester M

2017-08-01

The 2014 Medicaid expansion in participating states increased insurance coverage among people with chronic health conditions, but its implications for access to surgical care remain unclear. We investigated how Medicaid expansion influenced the insurance status of candidates for liver transplantation (LT) and transplant center payor mix. Data on LT candidates aged 18 to 64 years, in 2012 to 2013 (pre-expansion) and 2014 to 2015 (post-expansion), were obtained from the United Network for Organ Sharing registry. Change between the 2 periods in the percent of LT candidates using Medicaid was compared between expansion and nonexpansion states. Multivariable logistic regression was used to determine how Medicaid expansion influenced individual LT candidates' likelihood of using Medicaid insurance. The study included 33,017 LT candidates, of whom 29,666 had complete data for multivariable analysis. Medicaid enrollment increased by 4% after Medicaid expansion in participating states. One-quarter of the transplant centers in these states experienced ≥10% increase in the proportion of LT candidates using Medicaid insurance. Multivariable analysis confirmed that Medicaid expansion was associated with increased odds of LT candidates using Medicaid insurance (odds ratio 1.49; 95% CI 1.34, 1.66; p Medicaid expansion states during the post-expansion period. Candidates for LT became more likely to use Medicaid after the 2014 Medicaid expansion policy came into effect. Enactment of this policy did not appear to increase access to LT or address socioeconomic and demographic disparities in access to the LT wait list. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

DC-STAMP Is an Osteoclast Fusogen Engaged in Periodontal Bone Resorption.

Science.gov (United States)

Wisitrasameewong, W; Kajiya, M; Movila, A; Rittling, S; Ishii, T; Suzuki, M; Matsuda, S; Mazda, Y; Torruella, M R; Azuma, M M; Egashira, K; Freire, M O; Sasaki, H; Wang, C Y; Han, X; Taubman, M A; Kawai, T

2017-06-01

Dendritic cell-specific transmembrane protein (DC-STAMP) plays a key role in the induction of osteoclast (OC) cell fusion, as well as DC-mediated immune regulation. While DC-STAMP gene expression is upregulated in the gingival tissue with periodontitis, its pathophysiological roles in periodontitis remain unclear. To evaluate the effects of DC-STAMP in periodontitis, anti-DC-STAMP-monoclonal antibody (mAb) was tested in a mouse model of ligature-induced periodontitis ( n = 6-7/group) where Pasteurella pneumotropica ( Pp)-reactive immune response activated T cells to produce receptor activator of nuclear factor kappa-B ligand (RANKL), which, in turn, promotes the periodontal bone loss via upregulation of osteoclastogenesis. DC-STAMP was expressed on the cell surface of mature multinuclear OCs, as well as immature mononuclear OCs, in primary cultures of RANKL-stimulated bone marrow cells. Anti-DC-STAMP-mAb suppressed the emergence of large, but not small, multinuclear OCs, suggesting that DC-STAMP is engaged in the late stage of cell fusion. Anti-DC-STAMP-mAb also inhibited pit formation caused by RANKL-stimulated bone marrow cells. Attachment of ligature to a second maxillary molar induced DC-STAMP messenger RNA and protein, along with elevated tartrate-resistant acid phosphatase-positive (TRAP+) OCs and alveolar bone loss. As we expected, systemic administration of anti-DC-STAMP-mAb downregulated the ligature-induced alveolar bone loss. Importantly, local injection of anti-DC-STAMP-mAb also suppressed alveolar bone loss and reduced the total number of multinucleated TRAP+ cells in mice that received ligature attachment. Attachment of ligature induced significantly elevated tumor necrosis factor-α, interleukin-1β, and RANKL in the gingival tissue compared with the control site without ligature ( P < 0.05), which was unaffected by local injection with either anti-DC-STAMP-mAb or control-mAb. Neither in vivo anti- Pp IgG antibody nor in vitro anti- Pp T

Medicaid Enrollment Gap Length and Number of Medicaid Enrollment Periods Among US Children

Science.gov (United States)

Schoendorf, Kenneth C.

2014-01-01

Objectives. We examined gap length, characteristics associated with gap length, and number of enrollment periods among Medicaid-enrolled children in the United States. Methods. We linked the 2004 National Health Interview Survey to Medicaid Analytic eXtract files for 1999 through 2008. We examined linkage-eligible children aged 5 to 13 years in the 2004 National Health Interview Survey who disenrolled from Medicaid. We generated Kaplan-Meier curves of time to reenrollment. We used Cox proportional hazards models to assess the effect of sociodemographic variables on time to reenrollment. We compared the percentage of children enrolled 4 or more times across sociodemographic groups. Results. Of children who disenrolled from Medicaid, 35.8%, 47.1%, 63.5%, 70.8%, and 79.1% of children had reenrolled in Medicaid by 6 months, 1, 3, 5, and 10 years, respectively. Children who were younger, poorer, or of minority race/ethnicity or had lower educated parents had shorter gaps in Medicaid and were more likely to have had 4 or more Medicaid enrollment periods. Conclusions. Nearly half of US children who disenrolled from Medicaid reenrolled within 1 year. Children with traditionally high-risk demographic characteristics had shorter gaps in Medicaid enrollment and were more likely to have more periods of Medicaid enrollment. PMID:25033135

Development of Methods and Equipment for Sheet Stamping

Science.gov (United States)

Botashev, A. Yu; Bisilov, N. U.; Malsugenov, R. S.

2018-03-01

New methods of sheet stamping were developed: the gas forming with double-sided heating of a blank part and the gas molding with backpressure. In case of the first method the blank part is heated to the set temperature by means of a double-sided impact of combustion products of gas mixtures, after which, under the influence of gas pressure a stamping process is performed. In case of gas molding with backpressure, the blank part is heated to the set temperature by one-sided impact of the combustion products, while backpressure is created on the opposite side of the blank part by compressed air. In both methods the deformation takes place in the temperature range of warm or hot treatment due to the heating of a blank part. This allows one to form parts of complicated shape within one technological operation, which significantly reduces the cost of production. To implement these methods, original devices were designed and produced, which are new types of forging and stamping equipment. Using these devices, an experimental research on the stamping process was carried out and high-quality parts were obtained, which makes it possible to recommend the developed methods of stamping in the industrial production. Their application in small-scale production will allow one to reduce the cost price of stamped parts 2 or 3 times.

Postage stamps: A convergence of metallurgy, art, and history

Science.gov (United States)

Habashi, Fathi

2002-04-01

Postage stamps have been used around the world to commemorate, in miniature, significant events and people, including those of importance in the history of metals and mineral production. From the presence of gold artifacts in an ancient Egyptian tomb to the role of uranium in nuclear power, stamps have captured the evolution of metallurgical processes. This article highlights some of those stamps.

Minerals on postage stamps: A mix of art, history, economics and geography

Science.gov (United States)

Glover, Paul

2010-05-01

Most people would agree that minerals represent some of the most beautiful natural objects known to mankind, especially in the form of precious and semi-precious gemstones. It is hardly surprising, therefore, that they are often illustrated on stamps. Examples are the fine crystalline forms represented as coloured etchings in the French 1986 issue, and the stylized simplicity of the mineral stamps that were part of the Swiss Pro Patria series, issued annually between 1958 and 1961. I aim in this presentation to introduce the beautiful world of mineral illustrations on stamps. The talk cannot be comprehensive because of the very large number of minerals and stamps concerned, but it will introduce the range of minerals depicted on stamps, then look in some greater detail at several sets from France, Southern Africa and East Germany. Minerals become the subject of sets of stamps for many reasons. In many cases, it is part of an attempt by the particular national post office to depict the whole of the natural history of their country in stamp form - a statement of nationality and politics. The 1986 French issue was an example which followed sets of stamps that had already portrayed insects, flowers, trees and birds native to France. We also find that certain countries have produced several sets of stamps to mark the importance to their economy of mining particular minerals. Many African states depend upon minerals for much of their wealth and economic power, explaining why, for instance, Sierra Leone issued over 35 stamps on the subject of diamonds between 1965 and 1978, and why over 77% of mineral stamps come from countries with major mining interests. Countries with traditional links with the history of the study of geology and mining also produce mineral stamps. These are usually European countries with a long record of the study of the Earth, such as Germany and Switzerland. Curiously enough, though, despite its fine tradition of geological observation and research

Fast thermal nanoimprint lithography by a stamp with integrated heater

DEFF Research Database (Denmark)

Tormen, Massimo; Malureanu, Radu; Pedersen, Rasmus Haugstrup

2008-01-01

We propose fast nanoimprinting lithography (NIL) process based on the use of stamps with integrated heater. The latter consists of heavily ion implantation n-type doped silicon layer buried below the microstructured surface of the stamp. The stamp is heated by Joule effect, by 50 μs 25 Hz...

Patterning of polymers: precise channel stamping by optimizing wetting properties

International Nuclear Information System (INIS)

Seemann, Ralf; Kramer, Edward J; Lange, Frederick F

2004-01-01

Channel stamping is a soft lithography technique that can be used to fabricate small structures of polymeric materials. This technique is cheap and easy but a considerable drawback is the fact that reproduction of the patterns of the stamp is often imprecise due to the wetting properties of liquid and stamp. In this paper, we report on experiments that reveal the parameters governing the behaviour of liquids in grooves and on edges. Optimizing these parameters leads to better-quality channel-stamped structures and enables the design of sophisticated structured polymeric materials, allowing channels as small as about 100 nm to be fabricated. Moreover, we show that it is even possible to build up a freestanding three-dimensional structure by stamping line patterns on top of each other

78 FR 10201 - Proposed Information Collection; Electronic Duck Stamp Program

Science.gov (United States)

2013-02-13

..., Interior. ACTION: Notice; request for comments. SUMMARY: We (U.S. Fish and Wildlife Service) will ask the... refuges where admission is charged. Duck Stamps and products that bear stamp images are also popular... fee the State will charge for issuance of an electronic stamp. Description of the process the State...

SPS commemorative stamp

CERN Multimedia

1977-01-01

The turn on of the SPS was commemorated in France by the issue of a CERN stamp. The date of issue, 22 Octber 1976, coincided with the first tests of the beam line taking particles to experiments in the West Hall. (CERN Courier 1976 p. 382)

Use of Medicaid and housing data may help target areas of high asthma prevalence

Science.gov (United States)

Objective: To determine if there was a significant difference between mold contamination and asthma prevalence in Detroit and non-Detroit Michigan homes, between newer and older homes, and if there is a correlation between mold contamination and measures of Medicaid use for asthm...

Medicaid Primary Care Physician Fees and the Use of Preventive Services among Medicaid Enrollees

Science.gov (United States)

Atherly, Adam; Mortensen, Karoline

2014-01-01

Objective The Patient Protection and Affordable Care Act (ACA) increases Medicaid physician fees for preventive care up to Medicare rates for 2013 and 2014. The purpose of this paper was to model the relationship between Medicaid preventive care payment rates and the use of U.S. Preventive Services Task Force (USPSTF)–recommended preventive care use among Medicaid enrollees. Data Sources/Study Session We used data from the 2003 and 2008 Medical Expenditure Panel Survey (MEPS), a national probability sample of the U.S. civilian, noninstitutionalized population, linked to Kaiser state Medicaid benefits data, including the state Medicaid-to-Medicare physician fee ratio in 2003 and 2008. Study Design Probit models were used to estimate the probability that eligible individuals received one of five USPSF-recommended preventive services. A difference-in-difference model was used to separate out the effect of changes in the Medicaid payment rate and other factors. Data Collection/Extraction Methods Data were linked using state identifiers. Principal Findings Although Medicaid enrollees had a lower rate of use of the five preventive services in univariate analysis, neither Medicaid enrollment nor changes in Medicaid payment rates had statistically significant effects on meeting screening recommendations for the five screenings. The results were robust to a number of different sensitivity tests. Individual and state characteristics were significant. Conclusions Our results suggest that although temporary changes in primary care provider payments for preventive services for Medicaid enrollees may have other desirable effects, they are unlikely to substantially increase the use of these selected USPSTF-recommended preventive care services among Medicaid enrollees. PMID:24628495

Digital time stamping system based on open source technologies.

Science.gov (United States)

Miskinis, Rimantas; Smirnov, Dmitrij; Urba, Emilis; Burokas, Andrius; Malysko, Bogdan; Laud, Peeter; Zuliani, Francesco

2010-03-01

A digital time stamping system based on open source technologies (LINUX-UBUNTU, OpenTSA, OpenSSL, MySQL) is described in detail, including all important testing results. The system, called BALTICTIME, was developed under a project sponsored by the European Commission under the Program FP 6. It was designed to meet the requirements posed to the systems of legal and accountable time stamping and to be applicable to the hardware commonly used by the national time metrology laboratories. The BALTICTIME system is intended for the use of governmental and other institutions as well as personal bodies. Testing results demonstrate that the time stamps issued to the user by BALTICTIME and saved in BALTICTIME's archives (which implies that the time stamps are accountable) meet all the regulatory requirements. Moreover, the BALTICTIME in its present implementation is able to issue more than 10 digital time stamps per second. The system can be enhanced if needed. The test version of the BALTICTIME service is free and available at http://baltictime. pfi.lt:8080/btws/ and http://baltictime.lnmc.lv:8080/btws/.

77 FR 11127 - Medicaid Program; Announcement of Medicaid Recovery Audit Contractors (RACs) Contingency Fee Update

Science.gov (United States)

2012-02-24

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-6034-N] Medicaid Program; Announcement of Medicaid Recovery Audit Contractors (RACs) Contingency Fee Update AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice. SUMMARY: This notice announces an...

A compact system for large-area thermal nanoimprint lithography using smart stamps

DEFF Research Database (Denmark)

Pedersen, Rasmus Haugstrup; Hansen, Ole; Kristensen, Anders

2008-01-01

We present a simple apparatus for thermal nanoimprint lithography. In this work, the stamp is designed to significantly reduce the requirements for pressure application on the external imprint system. By MEMS-based processing, an air cavity inside the stamp is created, and the required pressure...... for successful imprint is reduced. Additionally, the stamp is capable of performing controlled demolding after imprint. Due to the complexity of the stamp, a compact and cost-effective imprint apparatus can be constructed. The design and fabrication of the advanced stamp as well as the simple imprint equipment...

Programming the BasicStamp : using MacBS2

NARCIS (Netherlands)

Djajadiningrat, J.P.; Stienstra, M.

2004-01-01

This article explains how to program a BasicStamp microcontroller using a Macintosh. It takes an absolute beginner's perspective and talks you through the whole process including how to hook up a programmer board, how to write some programs in the BasisStamp language PBASIC, and how to do some

Efficient methods of nanoimprint stamp cleaning based on imprint self-cleaning effect

Energy Technology Data Exchange (ETDEWEB)

Meng Fantao; Chu Jinkui [Key Laboratory for Micro/Nano Technology and System of Liaoning Province, Dalian University of Technology, 116024 Dalian (China); Luo Gang; Zhou Ye; Carlberg, Patrick; Heidari, Babak [Obducat AB, SE-20125 Malmoe (Sweden); Maximov, Ivan; Montelius, Lars; Xu, H Q [Division of Solid State Physics, Lund University, Box 118, S-22100 Lund (Sweden); Nilsson, Lars, E-mail: ivan.maximov@ftf.lth.se [Department of Food Technology, Engineering and Nutrition, Lund University, Box 117, S-22100 Lund (Sweden)

2011-05-06

Nanoimprint lithography (NIL) is a nonconventional lithographic technique that promises low-cost, high-throughput patterning of structures with sub-10 nm resolution. Contamination of nanoimprint stamps is one of the key obstacles to industrialize the NIL technology. Here, we report two efficient approaches for removal of typical contamination of particles and residual resist from stamps: thermal and ultraviolet (UV) imprinting cleaning-both based on the self-cleaning effect of imprinting process. The contaminated stamps were imprinted onto polymer substrates and after demolding, they were treated with an organic solvent. The images of the stamp before and after the cleaning processes show that the two cleaning approaches can effectively remove contamination from stamps without destroying the stamp structures. The contact angles of the stamp before and after the cleaning processes indicate that the cleaning methods do not significantly degrade the anti-sticking layer. The cleaning processes reported in this work could also be used for substrate cleaning.

The Study on Weldability of Boron Steel and Hot-Stamped Steel by Using Laser Heat Source (Ⅲ) - Comparison on Laser Weldability of Boron Steel and Hot -Stamped Steel-

Energy Technology Data Exchange (ETDEWEB)

Choi, So Young; Kim, Jong Do [Korea Maritime and Ocean University, Busan (Korea, Republic of); Kim, Jong Su [Korea Institute of Machinery and Materials, Daejeon (Korea, Republic of)

2015-01-15

This study was conducted to compare the laser weldability of boron steel and hot-stamped steel. In general, boron steel is used in the hot-stamping process. Hot-stamping is a method for simultaneously forming and cooling boron steel in a press die after heating it to the austenitizing temperature. Hot-stamped steel has a strength of 1500 MPa or more. Thus, in this study, the laser weldability of boron steel and that of hot-stamped steel were investigated and compared. A continuous wave disk laser was used to produce butt and lap joints. In the butt welding, the critical cooling speed at which full penetration was obtained in the hot-stamped steel was lower than that of boron steel. In the lap welding, the joint widths were similar regardless of the welding speed when full penetration was obtained.

The Study on Weldability of Boron Steel and Hot-Stamped Steel by Using Laser Heat Source (Ⅲ) - Comparison on Laser Weldability of Boron Steel and Hot -Stamped Steel-

International Nuclear Information System (INIS)

Choi, So Young; Kim, Jong Do; Kim, Jong Su

2015-01-01

This study was conducted to compare the laser weldability of boron steel and hot-stamped steel. In general, boron steel is used in the hot-stamping process. Hot-stamping is a method for simultaneously forming and cooling boron steel in a press die after heating it to the austenitizing temperature. Hot-stamped steel has a strength of 1500 MPa or more. Thus, in this study, the laser weldability of boron steel and that of hot-stamped steel were investigated and compared. A continuous wave disk laser was used to produce butt and lap joints. In the butt welding, the critical cooling speed at which full penetration was obtained in the hot-stamped steel was lower than that of boron steel. In the lap welding, the joint widths were similar regardless of the welding speed when full penetration was obtained

Stamp Detection in Color Document Images

DEFF Research Database (Denmark)

Micenkova, Barbora; van Beusekom, Joost

2011-01-01

, moreover, it can be imprinted with a variable quality and rotation. Previous methods were restricted to detection of stamps of particular shapes or colors. The method presented in the paper includes segmentation of the image by color clustering and subsequent classification of candidate solutions...... by geometrical and color-related features. The approach allows for differentiation of stamps from other color objects in the document such as logos or texts. For the purpose of evaluation, a data set of 400 document images has been collected, annotated and made public. With the proposed method, recall of 83...

Time Stamp Synchronization of PEFP Distributed Control Systems

International Nuclear Information System (INIS)

Song, Young Gi; An, Eun Mi; Kwon, Hyeok Jung; Cho, Yong Sub

2010-01-01

Proton Engineering Frontier Project (PEFP) proton linac consists of several types of control systems, such as soft Input Output Controllers (IOC) and embedded IOC based on Experimental Physics Industrial Control System (EPICS) for each subsection of PEFP facility. One of the important factors is that IOC's time clock is synchronized. The synchronized time and time stamp can be achieved with Network Time Protocol (NTP) and EPICS time stamp record without timing hardware. The requirement of the time accuracy of IOCs is less than 1 second. The main objective of this study is to configure a master clock and produce Process Variable (PV) time stamps using local CPU time synchronized from the master clock. The distributed control systems are attached on PEFP control network

Direct stamping of silver nanoparticles toward residue-free thick electrode

Directory of Open Access Journals (Sweden)

Jiseok Kim, Kevin Wubs, Byeong-Soo Bae and Woo Soo Kim

2012-01-01

Full Text Available Direct stamping of functional materials has been developed for cost-effective and process-effective manufacturing of nano/micro patterns. However, there remain several challenging issues like the perfect removal of the residual layer and realization of high aspect ratio. We have demonstrated facile fabrication of flexible strain sensors that have microscale thick interdigitated capacitors with no residual layer by a simple direct stamping with silver nanoparticles (AgNPs. Polyurethane (PU prepolymer was utilized as an adhesive layer to transfer AgNPs more efficiently during the separation step of the flexible stamp from directly stamped AgNPs. Scanning electron microscopy images and energy dispersive x-ray spectroscopy analysis revealed residue-free transfer of microscale thick interdigitated electrodes onto two different flexible substrates (elastomeric and brittle for the application to highly sensitive strain sensors.

Medicaid: taking stock.

Science.gov (United States)

Davidson, S M

1993-01-01

In the last few years, Medicaid has attracted more than casual attention, one reflection of which is the fact that JHPPL has published five papers on the program in its last few issues. This paper, a sixth, takes a broader view of the program than is typically the case. After a critique of the five recent articles, I discuss several questions raised by them and reach the following conclusions: First, the states do not invest enough in producing program data suitable for policy analysis and research. One lesson: Better data and analysis can help the states to avoid expensive mistakes. Second, those policy analyses that have been offered fail to give sufficient attention to the political dimension of policy. That is one reason why policy choices produce unexpected effects. Third, since Medicaid is a relatively small player in the vast medical care market, incentives adopted by Medicaid officials throughout the country rarely have the desired effects. Finally, as long as Medicaid remains the principal mechanism to provide access to health care for the poor, it must be made as efficient and effective as possible. Yet, for both political and economic reasons, Medicaid can never be what its original planners had hoped, the vehicle for providing the poor with reliable access to mainstream medical care.

75 FR 23067 - Medicaid Program; State Flexibility for Medicaid Benefit Packages

Science.gov (United States)

2010-04-30

... mental illness, children with serious emotional disturbance, the disabled and elderly, individuals with... that children with serious mental and/or physical disorders often qualify for Medicaid on a basis of... that brought about equitable, decent care for Medicaid-eligible individuals experiencing mental illness...

A compact system for large-area thermal nanoimprint lithography using smart stamps

International Nuclear Information System (INIS)

Pedersen, R H; Hansen, O; Kristensen, A

2008-01-01

We present a simple apparatus for thermal nanoimprint lithography. In this work, the stamp is designed to significantly reduce the requirements for pressure application on the external imprint system. By MEMS-based processing, an air cavity inside the stamp is created, and the required pressure for successful imprint is reduced. Additionally, the stamp is capable of performing controlled demolding after imprint. Due to the complexity of the stamp, a compact and cost-effective imprint apparatus can be constructed. The design and fabrication of the advanced stamp as well as the simple imprint equipment is presented. Test imprints of micrometer- and nanometer-scale structures are performed and characterized with respect to uniformity across a large area (35 mm radius). State-of-the-art uniformity for µm-scale features is demonstrated

Barriers to Medicaid Participation among Florida Dentists

Science.gov (United States)

Logan, Henrietta L.; Catalanotto, Frank; Guo, Yi; Marks, John; Dharamsi, Shafik

2015-01-01

Background Finding dentists who treat Medicaid-enrolled children is a struggle for many parents. The purpose of this study was to identify non-reimbursement factors that influence the decision by dentists about whether or not to participate in the Medicaid program in Florida. Methods Data from a mailed survey was analyzed using a logistic regression model to test the association of Medicaid participation with the Perceived Barriers and Social Responsibility variables. Results General and pediatric dentists (n=882) who identified themselves as either Medicaid (14%) or Non-Medicaid (86%) participants responded. Five items emerged as significant predictors of Medicaid participation, with a final concordance index of 0.905. Two previously unreported barriers to participation in Medicaid emerged: 1) dentists’ perception of social stigma from other dentists for participating in Medicaid, and 2) the lack of specialists to whom Medicaid patients can be referred. Conclusions This study provides new information about non-reimbursement barriers to Medicaid participation. PMID:25702734

Medicaid Financial Management Data

Data.gov (United States)

U.S. Department of Health & Human Services — This dataset reports summary state-by-state total expenditures by program for the Medicaid Program, Medicaid Administration and CHIP programs. These state...

Use of tobacco tax stamps to prevent and reduce illicit tobacco trade--United States, 2014.

Science.gov (United States)

Chriqui, Jamie; DeLong, Hillary; Gourdet, Camille; Chaloupka, Frank; Edwards, Sarah Matthes; Xu, Xin; Promoff, Gabbi

2015-05-29

Tobacco use is the leading cause of preventable disease and death in the United States. Increasing the unit price on tobacco products is the most effective tobacco prevention and control measure. Illicit tobacco trade (illicit trade) undermines high tobacco prices by providing tobacco users with cheaper-priced alternatives. In the United States, illicit trade primarily occurs when cigarettes are bought from states, jurisdictions, and federal reservation land with lower or no excise taxes, and sold in jurisdictions with higher taxes. Applying tax stamps to tobacco products, which provides documentation that taxes have been paid, is an important tool to combat illicit trade. Comprehensive tax stamping policy, which includes using digital, encrypted ("high-tech") stamps, applying stamps to all tobacco products, and working with tribes on stamping agreements, can further prevent and reduce illicit trade. This report describes state laws governing tax stamps on cigarettes, little cigars (cigarette-sized cigars), roll-your-own tobacco (RYOT), and tribal tobacco sales across the United States as of January 1, 2014, and assesses the extent of comprehensive tobacco tax stamping in the United States. Forty-four states (including the District of Columbia [DC]) applied traditional paper ("low-tech") tax stamps to cigarettes, whereas four authorized more effective high-tech stamps. Six states explicitly required stamps on other tobacco products (i.e., tobacco products other than cigarettes), and in approximately one third of states with tribal lands, tribes required tax stamping to address illicit purchases by nonmembers. No U.S. state had a comprehensive approach to tobacco tax stamping. Enhancing tobacco tax stamping across the country might further prevent and reduce illicit trade in the United States.

Stamp duties in Indian states - a case for reform

OpenAIRE

Alm, James; Annez, Patricia; Modi, Arbind

2004-01-01

The authors review the options for reform of stamp duties on immovable property transfers collected by Indian state governments. After briefly reviewing some of the many administrative difficulties experienced with the tax, they turn to an examination of its economic impacts. A review of stamp duties internationally indicates that Indian rates are exceptionally high, at rates often above 1...

Medicaid Drug Claims Statistics

Data.gov (United States)

U.S. Department of Health & Human Services — The Medicaid Drug Claims Statistics CD is a useful tool that conveniently breaks up Medicaid claim counts and separates them by quarter and includes an annual count.

Lessons from Early Medicaid Expansions Under Health Reform: Interviews with Medicaid Officials

Science.gov (United States)

Sommers, Benjamin D; Arntson, Emily; Kenney, Genevieve M; Epstein, Arnold M

2013-01-01

Background The Affordable Care Act (ACA) dramatically expands Medicaid in 2014 in participating states. Meanwhile, six states have already expanded Medicaid since 2010 to some or all of the low-income adults targeted under health reform. We undertook an in-depth exploration of these six “early-expander” states—California, Connecticut, the District of Columbia, Minnesota, New Jersey, and Washington—through interviews with high-ranking Medicaid officials. Methods We conducted semi-structured interviews with 11 high-ranking Medicaid officials in six states and analyzed the interviews using qualitative methods. Interviews explored enrollment outreach, stakeholder involvement, impact on beneficiaries, utilization and costs, implementation challenges, and potential lessons for 2014. Two investigators independently analyzed interview transcripts and iteratively refined the codebook until reaching consensus. Results We identified several themes. First, these expansions built upon pre-existing state-funded insurance programs for the poor. Second, predictions about costs and enrollment were challenging, indicating the uncertainty in projections for 2014. Other themes included greater than anticipated need for behavioral health services in the expansion population, administrative challenges of expansions, and persistent barriers to enrollment and access after expanding eligibility—though officials overall felt the expansions increased access for beneficiaries. Finally, political context—support or opposition from stakeholders and voters—plays a critical role in shaping the success of Medicaid expansions. Conclusions Early Medicaid expansions under the ACA offer important lessons to federal and state policymakers as the 2014 expansions approach. While the context of each state’s expansion is unique, key shared experiences were significant implementation challenges and opportunities for expanding access to needed services. PMID:24834369

Medicaid Analytic eXtract (MAX) Chartbooks

Data.gov (United States)

U.S. Department of Health & Human Services — The Medicaid Analytic eXtract Chartbooks are research tools and reference guides on Medicaid enrollees and their Medicaid experience in 2002 and 2004. Developed for...

METAMORPHOSES OF THE ENVIRONMENTAL STAMP IN ROMANIA

Directory of Open Access Journals (Sweden)

CARAUS MADALINA

2015-12-01

Full Text Available Romania's alignment to European standards is a difficult process with many legislative changes, with direct impact on taxpayers. The necessity of collecting substantial revenues to the State budget, which provide vital economic growth of the Romanian State, loses the substance when we are talking about taxes levied in relation to taxpayer. The environmental stamp, otherwise a controversial tax, represent for the State another way to earn revenue in advance, “as a loan", because in the end it's forced to repay the amounts concerned taxpayers, under the effect of a final and irrevocable court decision. The effects of the legislative changes bring every time complaints both from taxpayers, because they can demand repayment of the environmental stamp only during the period of prescription, as well as on the part of public servants who are grappling with a large volume of work, with the possibility of overcoming the term to handle requests. An equitable solution in solving these distortions would be the inclusion of the environmental stamp within the tax on means of transport, tax that is paid annually by vehicle owners. At the moment the level of the environmental stamp is calculated depending on the CO2 emissions, exhaust emissions and the age of the vehicle. Tax on means of transport is calculated based on engine capacity, an amount determined by CO2 emissions multiplying with each group of 200 cc or fraction on it. Therefore the unification of the two taxes would create a balance for all categories of vehicles.

Application of Modified Digital Halftoning Techniques to Data Hiding in Personalized Stamps

Institute of Scientific and Technical Information of China (English)

Hsi-Chun Wang; Chi-Ming Lian; Pei-Chi Hsiao

2004-01-01

The objective of this research is to embed information in personalized stamps by modified digital halftoning techniques. The displaced and deformed halftone dots are used to encode data in the personalized stamps. Hidden information can be retrieved by either an optical decoder or digital image processing techniques.The results show that personalized stamps with value-added features like data hiding or digital watermarking can be successfully implemented.

Analysis of roll-stamped light guide plate fabricated with laser-ablated stamper

Science.gov (United States)

Na, Hyunjun; Hong, Seokkwan; Kim, Jongsun; Hwang, Jeongho; Joo, Byungyun; Yoon, Kyunghwan; Kang, Jeongjin

2017-12-01

LGP (light guide plate) is one of the major components of LCD (liquid crystal display), and it makes surface illumination for LCD backlit. LGP is a transparent plastic plate usually produced by injection molding process. On the back of LGP there are micron size patterns for extraction of light. Recently a roll-stamping process has achieved the high mass productivity of thinner LGPs. In order to fabricate optical patterns on LGPs, a fabricating tool called as a stamper is used. Micro patterns on metallic stampers are made by several micro machining processes such as chemical etching, LIGA-reflow, and laser ablation. In this study, a roll-stamping process by using a laser ablated metallic stamper was dealt with in consideration of the compatibility with the roll-stamping process. LGP fabricating tests were performed using a roll-stamping process with four different roll pressures. Pattern shapes on the stamper fabricated by laser ablation and transcription ratios of the roll-stamping process were analyzed, and LGP luminance was evaluated. Based on the evaluation, optical simulation model for LGP was made and simulation accuracy was evaluated. Simulation results showed good agreements with optical performance of LGPs in the brightness and uniformity. It was also shown that the roll-stamped LGP has the possibility of better optical performance than the conventional injection molded LGP. It was also shown that the roll-stamped LGP with the laser ablated stamper is potential to have better optical performance than the conventional injection molded LGP.

State-level Medicaid expenditures attributable to smoking.

Science.gov (United States)

Armour, Brian S; Finkelstein, Eric A; Fiebelkorn, Ian C

2009-07-01

Medicaid recipients are disproportionately affected by tobacco-related disease because their smoking prevalence is approximately 53% greater than that of the overall US adult population. This study estimates state-level smoking-attributable Medicaid expenditures. We used state-level and national data and a 4-part econometric model to estimate the fraction of each state's Medicaid expenditures attributable to smoking. These fractions were multiplied by state-level Medicaid expenditure estimates obtained from the Centers for Medicare and Medicaid Services to estimate smoking-attributable expenditures. The smoking-attributable fraction for all states was 11.0% (95% confidence interval, 0.4%-17.0%). Medicaid smoking-attributable expenditures ranged from $40 million (Wyoming) to $3.3 billion (New York) in 2004 and totaled $22 billion nationwide. Cigarette smoking accounts for a sizeable share of annual state Medicaid expenditures. To reduce smoking prevalence among recipients and the growth rate in smoking-attributable Medicaid expenditures, state health departments and state health plans such as Medicaid are encouraged to provide free or low-cost access to smoking cessation counseling and medication.

75 FR 82397 - Medicaid Program: Initial Core Set of Health Quality Measures for Medicaid-Eligible Adults

Science.gov (United States)

2010-12-30

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Secretary [CMS-2420-NC] Medicaid Program: Initial Core Set of Health Quality Measures for Medicaid-Eligible Adults AGENCY: Office of the Secretary... quality measures recommended for Medicaid-eligible adults, as required by section 2701 of the Affordable...

Equity in Medicaid Reimbursement for Otolaryngologists.

Science.gov (United States)

Conduff, Joseph H; Coelho, Daniel H

2017-12-01

Objective To study state Medicaid reimbursement rates for inpatient and outpatient otolaryngology services and to compare with federal Medicare benchmarks. Study Design State and federal database query. Setting Not applicable. Methods Based on Medicare claims data, 26 of the most common Current Procedural Terminology codes reimbursed to otolaryngologists were selected and the payments recorded. These were further divided into outpatient and operative services. Medicaid payment schemes were queried for the same services in 49 states and Washington, DC. The difference in Medicaid and Medicare payment in dollars and percentage was determined and the reimbursement per relative value unit calculated. Medicaid reimbursement differences (by dollar amount and by percentage) were qualified as a shortfall or excess as compared with the Medicare benchmark. Results Marked differences in Medicaid and Medicare reimbursement exist for all services provided by otolaryngologists, most commonly as a substantial shortfall. The Medicaid shortfall varied in amount among states, and great variability in reimbursement exists within and between operative and outpatient services. Operative services were more likely than outpatient services to have a greater Medicaid shortfall. Shortfalls and excesses were not consistent among procedures or states. Conclusions The variation in Medicaid payment models reflects marked differences in the value of the same work provided by otolaryngologists-in many cases, far less than federal benchmarks. These results question the fairness of the Medicaid reimbursement scheme in otolaryngology, with potential serious implications on access to care for this underserved patient population.

27 CFR 70.332 - Unauthorized use or sale of stamps.

Science.gov (United States)

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 2 2010-04-01 2010-04-01 false Unauthorized use or sale....332 Unauthorized use or sale of stamps. Any person who buys, sells, offers for sale, uses, transfers... Code or in regulations made pursuant thereto, any stamp, coupon, ticket, book, or other device...

Carbon nanotube substrates and catalyzed hot stamp for polishing and patterning the substrates

Science.gov (United States)

Wang, Yuhuang [Evanston, IL; Hauge, Robert H [Houston, TX; Schmidt, Howard K [Houston, TX; Kim, Myung Jong [Houston, TX; Kittrell, W Carter [Houston, TX

2009-09-08

The present invention is generally directed to catalyzed hot stamp methods for polishing and/or patterning carbon nanotube-containing substrates. In some embodiments, the substrate, as a carbon nanotube fiber end, is brought into contact with a hot stamp (typically at 200-800.degree. C.), and is kept in contact with the hot stamp until the morphology/patterns on the hot stamp have been transferred to the substrate. In some embodiments, the hot stamp is made of material comprising one or more transition metals (Fe, Ni, Co, Pt, Ag, Au, etc.), which can catalyze the etching reaction of carbon with H.sub.2, CO.sub.2, H.sub.2O, and/or O.sub.2. Such methods can (1) polish the carbon nanotube-containing substrate with a microscopically smooth finish, and/or (2) transfer pre-defined patterns from the hot stamp to the substrate. Such polished or patterned carbon nanotube substrates can find application as carbon nanotube electrodes, field emitters, and field emitter arrays for displays and electron sources.

Discontinuity of Medicaid Coverage: Impact on Cost and Utilization Among Adult Medicaid Beneficiaries With Major Depression.

Science.gov (United States)

Ji, Xu; Wilk, Adam S; Druss, Benjamin G; Lally, Cathy; Cummings, Janet R

2017-08-01

Gaps in Medicaid coverage may disrupt access to and continuity of care. This can be detrimental for beneficiaries with chronic conditions, such as major depression, for whom disruptions in access to outpatient care may lead to increased use of acute care. However, little is known about how Medicaid coverage discontinuities impact acute care utilization among adults with depression. Examine the relationship between Medicaid discontinuities and service utilization among adults with major depression. A total of 139,164 adults (18-64) with major depression was identified using the 2003-2004 Medicaid Analytic eXtract Files. We used generalized linear and two-part models to examine the effect of Medicaid discontinuity on service utilization. To establish causality in this relationship, we used instrumental variables analysis, relying on exogenous variation in a state-level policy for identification. Emergency department (ED) visits, inpatient episodes, inpatient days, and Medicaid-reimbursed costs. Approximately 29.4% of beneficiaries experienced coverage disruptions. In instrumental variables models, those with coverage disruptions incurred an increase of $650 in acute care costs per-person per Medicaid-covered month compared with those with continuous coverage, evidenced by an increase in ED use (0.1 more ED visits per-person-month) and inpatient days (0.6 more days per-person-month). The increase in acute costs contributed to an overall increase in all-cause costs by $310 per-person-month (all P-valuesMedicaid coverage may help prevent acute episodes requiring high-cost interventions.

Resistless Fabrication of Nanoimprint Lithography (NIL Stamps Using Nano-Stencil Lithography

Directory of Open Access Journals (Sweden)

Juergen Brugger

2013-10-01

Full Text Available In order to keep up with the advances in nano-fabrication, alternative, cost-efficient lithography techniques need to be implemented. Two of the most promising are nanoimprint lithography (NIL and stencil lithography. We explore here the possibility of fabricating the stamp using stencil lithography, which has the potential for a cost reduction in some fabrication facilities. We show that the stamps reproduce the membrane aperture patterns within ±10 nm and we validate such stamps by using them to fabricate metallic nanowires down to 100 nm in size.

Economic impacts of Medicaid in North Carolina.

Science.gov (United States)

Dumas, Christopher; Hall, William; Garrett, Patricia

2008-01-01

The purpose of this study is to provide estimates of the economic impacts of Medicaid program expenditures in North Carolina in state fiscal year (SFY) 2003. The study uses input-output analysis to estimate the economic impacts of Medicaid expenditures. The study uses North Carolina Medicaid program expenditure data for SFY 2003 as submitted by the North Carolina Division of Medical Assistance to the federal Centers for Medicare and Medicaid Services (CMS). Industry structure data from 2002 that are part of the IMPLAN input-output modeling software database are also used in the analysis. In SFY 2003 $6.307 billion in Medicaid program expenditures occurred within the state of North Carolina-$3.941 billion federal dollars, $2.014 billion state dollars, and $351 million in local government funds. Each dollar of state and local government expenditures brought $1.67 in federal Medicaid cost-share to the state. The economic impacts within North Carolina of the 2003 Medicaid expenditures included the following: 182,000 jobs supported (including both full-time and some part-time jobs); $6.1 billion in labor income (wages, salaries, sole proprietorship/partnership profits); and $1.9 billion in capital income (rents, interest payments, corporate dividend payments). If the Medicaid program were shut down and the funds returned to taxpayers who saved/spent the funds according to typical consumer expenditure patterns, employment in North Carolina would fall by an estimated 67,400 jobs, and labor income would fall by $2.83 billion, due to the labor-intensive nature of Medicaid expenditures. Medicaid expenditure and economic impact results do not capture the economic value of the improved health and well-being of Medicaid recipients. Furthermore, the results do not capture the savings to society from increased preventive care and reduced uncompensated care resulting from Medicaid. State and local government expenditures do not fully capture the economic consequences of Medicaid

42 CFR 430.3 - Appeals under Medicaid.

Science.gov (United States)

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Appeals under Medicaid. 430.3 Section 430.3 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... Provisions § 430.3 Appeals under Medicaid. Three distinct types of disputes may arise under Medicaid. (a...

The quality of Medicaid and Medicare data obtained from CMS and its contractors: implications for pharmacoepidemiology.

Science.gov (United States)

Leonard, Charles E; Brensinger, Colleen M; Nam, Young Hee; Bilker, Warren B; Barosso, Geralyn M; Mangaali, Margaret J; Hennessy, Sean

2017-04-26

Administrative claims of United States Centers for Medicare and Medicaid Services (CMS) beneficiaries have long been used in non-experimental research. While CMS performs in-house checks of these claims, little is known of their quality for conducting pharmacoepidemiologic research. We performed exploratory analyses of the quality of Medicaid and Medicare data obtained from CMS and its contractors. Our study population consisted of Medicaid beneficiaries (with and without dual coverage by Medicare) from California, Florida, New York, Ohio, and Pennsylvania. We obtained and compiled 1999-2011 data from these state Medicaid programs (constituting about 38% of nationwide Medicaid enrollment), together with corresponding national Medicare data for dually-enrolled beneficiaries. This descriptive study examined longitudinal patterns in: dispensed prescriptions by state, by quarter; and inpatient hospitalizations by federal benefit, state, and age group. We further examined discrepancies between demographic characteristics and disease states, in particular frequencies of pregnancy complications among men and women beyond childbearing age, and prostate cancers among women. Dispensed prescriptions generally increased steadily and consistently over time, suggesting that these claims may be complete. A commercially-available National Drug Code lookup database was able to identify the dispensed drug for 95.2-99.4% of these claims. Because of co-coverage by Medicare, Medicaid data appeared to miss a substantial number of hospitalizations among beneficiaries ≥ 45 years of age. Pregnancy complication diagnoses were rare in males and in females ≥ 60 years of age, and prostate cancer diagnoses were rare in females. CMS claims from five large states obtained directly from CMS and its contractors appeared to be of high quality. Researchers using Medicaid data to study hospital outcomes should obtain supplemental Medicare data on dual enrollees, even for non-elders. Not

Stamping the Earth from space

CERN Document Server

Dicati, Renato

2017-01-01

This unique book presents a historical and philatelic survey of Earth exploration from space. It covers all areas of research in which artificial satellites have contributed in designing a new image of our planet and its environment: the atmosphere and ionosphere, the magnetic field, radiation belts and the magnetosphere, weather, remote sensing, mapping of the surface, observation of the oceans and marine environments, geodesy, and the study of life and ecological systems. Stamping the Earth from Space presents the results obtained with the thousands of satellites launched by the two former superpowers, the Soviet Union and the United States, and also those of the many missions carried out by the ESA, individual European countries, Japan, China, India, and the many emerging space nations. Beautifully illustrated, it contains almost 1100 color reproductions of philatelic items. In addition to topical stamps and thematic postal documents, the book provides an extensive review of astrophilatelic items. The most...

POLYELECTROLYTE MULTILAYER STAMPING IN AQUEOUS PHASE AND NON-CONTACT MODE

Science.gov (United States)

Mehrotra, Sumit; Lee, Ilsoon; Liu, Chun; Chan, Christina

2011-01-01

Polyelectrolyte multilayer (PEM) transfer printing has been previously achieved by stamping under dry conditions. Here, we show for the first time, that PEM can be transferred from a stamp to the base substrate under aqueous conditions whereby the two surfaces are in a non-contact mode. Degradable multilayers of (PAA/PEG)10.5 followed by non-degradable multilayers of (PDAC/SPS)80.5 were fabricated under acidic pH conditions on either PDMS or glass (stamp), and subsequently transferred over top of another multilayer prepared on a different substrate (base substrate), with a spacing of ~ 200 μm between the stamping surface and the base substrate. This multilayer transfer was performed under physiological pH conditions. This process is referred to herein as non-contact, aqueous-phase multilayer (NAM) transfer. NAM transfer can be useful for applications such as fabricating three-dimensional (3-D) cellular scaffolds. We attempted to create a 3-D cellular scaffold using NAM transfer, and characterized the scaffolds with conventional and fluorescence microscopy. PMID:21860540

Impact of Maine's Medicaid drug formulary change on non-Medicaid markets: spillover effects of a restrictive drug formulary.

Science.gov (United States)

Wang, Y Richard; Pauly, Mark V; Lin, Y Aileen

2003-10-01

Market penetration of HMOs affect physician practice styles for non-HMO patients. To study the impact of a restrictive Medicaid drug formulary on prescribing patterns for other patients, ie, so-called spillover effects. A before-and-after, 3-state comparison study. On January 1, 2001, Maine's Medicaid program implemented a restrictive drug formulary for the proton pump inhibitor class, with pantoprazole as the only preferred drug. The Medicaid and non-Medicaid market shares of pantoprazole in Maine (vs New Hampshire and Vermont and among Maine physicians with different Medicaid share of practice. After 3 months, the market share of pantoprazole in Maine (vs 2 control states) increased 79% among Medicaid prescriptions (vs 1%-2%), 10% among cash prescriptions (vs 3%), and 7% among other third-party payer prescriptions (vs 1%). The market shares increased more among Maine physicians with a higher Medicaid share of practice (high vs middle vs low [market]: 16% vs 8% vs 5% [cash]; 11% vs 5% vs 4% [other third-party payers]). Linear regression results indicate that practicing medicine in Maine leads to a 72% increase in pantoprazole share among Medicaid prescriptions (P markets, with somewhat stronger effects in the cash market.

42 CFR 460.182 - Medicaid payment.

Science.gov (United States)

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Medicaid payment. 460.182 Section 460.182 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED...) Payment § 460.182 Medicaid payment. (a) Under a PACE program agreement, the State administering agency...

42 CFR 435.930 - Furnishing Medicaid.

Science.gov (United States)

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Furnishing Medicaid. 435.930 Section 435.930 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED..., AND AMERICAN SAMOA Eligibility in the States and District of Columbia Furnishing Medicaid § 435.930...

Mathematical Modeling of Hydroelastic Oscillations of the Stamp and the Plate, Resting on Pasternak Foundation

Science.gov (United States)

Mogilevich, L. I.; Popov, V. S.; Popova, A. A.; Christoforova, A. V.

2018-01-01

The forced oscillations of the elastic fixed stamp and the plate, resting on Pasternak foundation are studied. The oscillations are caused by pressure pulsation in liquid layer between the stamp and the plate. Pasternak model is chosen as an elastic foundation. The laws of the stamp movement, the plate deflection and pressure in the liquid are discovered on the basis of hydroelasticity problem analytical solution. The functions of amplitude deflection distribution and liquid pressure along the plate are constructed, as well as the stamp amplitude-frequency characteristic. The obtained mathematical model allows to investigate the dynamics of hydroelastic interaction of the stamp with the plate, resting on elastic foundation, to define resonance frequencies of the plate and the stamp and corresponding deflections amplitudes, as well as liquid presser amplitudes.

Bifunctional, Chemically Patterned Flat Stamps for Microcontact Printing of Polar Inks

NARCIS (Netherlands)

Duan, X.; Sadhu, V.B.; Perl, A.; Péter, M.; Reinhoudt, David; Huskens, Jurriaan

2008-01-01

Different methods to create chemically patterned, flat PDMS stamps with two different chemical functionalities were compared. The best method for making such stamps, functionalized with 1H,1H,2H,2H-perfluorodecyltrichlorosilane (PFDTS) and 3-(aminopropyl)triethoxysilane (APTS), appeared to be full

Single women and the dynamics of Medicaid.

Science.gov (United States)

Short, P F; Freedman, V A

1998-01-01

OBJECTIVE: To investigate transitions in and out of Medicaid for a cohort of single adult women of childbearing age in order to address questions that arise as policymakers try to encourage transitions from welfare to work. DATA SOURCES: Longitudinal data from Waves 2 through 8 of the 1990 panel of the Survey of Income and Program Participation, a nationally representative survey of American adults covering May 1990-1992. STUDY DESIGN: We estimate a series of discrete-time logit models with duration dependence to obtain transition probabilities among Medicaid, privately insured, and uninsured spells. Explanatory variables in the models include prior insurance history, income limits on Medicaid by state, and important socioeconomic and demographic characteristics. We use these models to characterize insurance spells for a cohort of single women. PRINCIPAL FINDINGS: Most Medicaid spells are relatively short. Over half end in a year or less; only one spell out of seven lasts longer than five years. Two-thirds of Medicaid disenrollees become uninsured. Former welfare recipients are prone to frequent changes in insurance status. In states with more generous income limits for AFDC, women stay on Medicaid longer, but they do not move into the program at a faster rate. CONCLUSIONS: Imposing time limits on Medicaid eligibility would affect only a small proportion of Medicaid spells but would eliminate a significant proportion of the caseload at a point in time. In considering changes in Medicaid that would encourage transitions from welfare to work and would alter the dynamics of Medicaid, policymakers need to consider how transitions both in and out of private insurance and Medicaid would be affected. Images Figure 2 Figure 3 Figure 4 PMID:9865222

Medicaid Disproportionate Share Hospital Payments

Data.gov (United States)

U.S. Department of Health & Human Services — Medicaid Disproportionate Share Hospital (DSH) Payments This link provides you with information about Medicaid DSH Payments. You can find information on DSH Audit...

Medicare and Medicaid Linked Files

Data.gov (United States)

U.S. Department of Health & Human Services — The Medicare-Medicaid Linked Enrollee Analytic Data Source (MMLEADS) has been developed to allow for the examination of all Medicare and Medicaid enrollment and...

41 CFR 101-25.103-3 - Trading stamps or bonus goods received from contractors.

Science.gov (United States)

2010-07-01

... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Trading stamps or bonus... PROCUREMENT 25-GENERAL 25.1-General Policies § 101-25.103-3 Trading stamps or bonus goods received from contractors. When contracts contain a price reduction clause, any method (such as trading stamps or bonus...

Influence of preconsolidation on consolidation quality after stamp forming of C/PEEK composites

Science.gov (United States)

Slange, T. K.; Warnet, L.; Grouve, W. J. B.; Akkerman, R.

2016-10-01

Stamp forming is a rapid manufacturing technology used to shape flat blanks of thermoplastic composite material into three-dimensional components. Currently, expensive autoclave and press consolidation are used to preconsolidate blanks. This study investigates the influence of preconsolidation on final consolidation quality after stamp forming and explores the potential of alternative blank manufacturing methods that could reduce part costs. Blanks were manufactured using various blank manufacturing methods and subsequently were stamp formed. The consolidation quality both before and after stamp forming was compared, where the focus was on void content as the main measure for consolidation quality. The void content was characterized through thickness and density measurements, as well as by microscopy analysis. Results indicate that preconsolidation quality does have an influence on the final consolidation quality. This is due to the severe deconsolidation and limited reconsolidation during stamp forming. Nevertheless, the potential of automated fiber placement and ultrasonic spot welding as alternative blank manufacturing methods was demonstrated.

45 CFR 162.1901 - Medicaid pharmacy subrogation transaction.

Science.gov (United States)

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Medicaid pharmacy subrogation transaction. 162... STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Medicaid Pharmacy Subrogation § 162.1901 Medicaid pharmacy subrogation transaction. The Medicaid pharmacy subrogation transaction is the...

Time-stamping system for nuclear physics experiments at RIKEN RIBF

International Nuclear Information System (INIS)

Baba, H.; Ichihara, T.; Ohnishi, T.; Takeuchi, S.; Yoshida, K.; Watanabe, Y.; Ota, S.; Shimoura, S.; Yoshinaga, K.

2015-01-01

A time-stamping system for nuclear physics experiments has been introduced at the RIKEN Radioactive Isotope Beam Factory. Individual trigger signals can be applied for separate data acquisition (DAQ) systems. After the measurements are complete, separately taken data are merged based on the time-stamp information. In a typical experiment, coincidence trigger signals are formed from multiple detectors to take desired events only. The time-stamping system allows the use of minimum bias triggers. Since coincidence conditions are given by software, a variety of physics events can be flexibly identified. The live time for a DAQ system is important when attempting to determine reaction cross-sections. However, the combined live time for separate DAQ systems is not clearly known because it depends not only on the DAQ dead time but also on the coincidence conditions. Using the proposed time-stamping system, all trigger timings can be acquired, so that the combined live time can be easily determined. The combined live time is also estimated using Monte Carlo simulations, and the results are compared with the directly measured values in order to assess the accuracy of the simulation

Comparison between Laser and Stamping without Die (SWD for Micro Tapered Hole Forming

Directory of Open Access Journals (Sweden)

Yung-Chou Hung

2016-03-01

Full Text Available The forming of a micro tapered hole is based on nanosecond pulsed laser processing, which conforms to fast processing time and high throughput; however, the microhole quality should be improved. Micro stamping is a technology providing high precise size and speed. The greatest difficulty in forming a microhole by micro stamping is the precision alignment of the punch head to the lower die. In order to overcome the difficulty, we proposed a concept of stamping without die (SWD. Without a lower die, the tapered punch head was directly applied to the workpiece for micro stamping, and a thicker workpiece surrounding the punching area provides a better support to the stamping process. Thus, a successful forming of micro tapered holes is completed. The micro tapered hole depth is 300 μm, and the maximum ratio of inlet to outlet diameter is 18:1. In order to reduce the number of experiments, the finite element analysis software DEFORM-3D was used for forming analysis. The simulation forecast result was compared with the experimental processing, which was well validated. Under different experimental parameters of laser energy and defocusing distance, drilling results by two methods show that the microhole quality by stamping process is better than by laser processing.

Characteristic Evaluation of Organic Light-Emitting Diodes Prepared with Stamp Printing Technique

Directory of Open Access Journals (Sweden)

Apisit Chittawanij

2017-01-01

Full Text Available We have reported on a stamp printing technique that uses PET release film as a printing stamp to deposit TPBi thin film served as the electron transport layer of the organic light-emitting diodes. TPBi thin film was printed with a good uniformity and resolution. Effect of deposition conditions on optical and electrical properties and surface roughness of TPBi thin film have been studied under spectroscopy and atomic force microscopy, respectively. It is found that characteristic of TPBi thin film is improved via controlled stamp temperature and time. Since TPBi thin film exhibits the surface morphology comparable to that of conventional spin-coating thin film, our findings suggest that PET release film-based stamp printing approach is possible to use as an alternative deposition of the organic thin film as compared with a traditional one.

77 FR 5317 - Medicaid Program; Covered Outpatient Drugs

Science.gov (United States)

2012-02-02

... for Medicare & Medicaid Services 42 CFR Part 447 Medicaid Program; Covered Outpatient Drugs; Proposed... Part 447 [CMS-2345-P] RIN 0938-AQ41 Medicaid Program; Covered Outpatient Drugs AGENCY: Centers for... requirements pertaining to Medicaid reimbursement for covered outpatient drugs to implement provisions of the...

Determination of the interfacial heat transfer coefficient in the hot stamping of AA7075

Directory of Open Access Journals (Sweden)

Liu Xiaochuan

2015-01-01

Full Text Available The interfacial heat transfer coefficient (IHTC is a key parameter in hot stamping processes, in which a hot blank is formed and quenched by cold dies simultaneously. The IHTC should therefore be identified and used in FE models to improve the accuracy of simulation results of hot stamping processes. In this work, a hot stamping simulator was designed and assembled in a Gleeble 3800 thermo-mechanical testing system and a FE model was built in PAM-STAMP to determine the IHTC value between a hot aluminium alloy 7075 blank and cold dies. The IHTC was determined at different contact pressures under both dry and lubricated (Omega-35 conditions. In addition, a model to calculate the IHTC value at different contact pressures and area densities of lubricant was developed for the hot stamping process.

Evaluating State Options for Reducing Medicaid Churning

Science.gov (United States)

Swartz, Katherine; Short, Pamela Farley; Graefe, Deborah R.; Uberoi, Namrata

2015-01-01

Medicaid churning - the constant exit and re-entry of beneficiaries as their eligibility changes - has long been a problem for both Medicaid administrators and recipients. Churning will continue under the Affordable Care Act, because despite new federal rules, Medicaid eligibility will continue to be based on current monthly income. We developed a longitudinal simulation model to evaluate four policy options for modifying or extending Medicaid eligibility to reduce churning. The simulations suggest that two options, extending Medicaid eligibility either to the end of a calendar year or for twelve months after enrollment, would be far more effective in reducing churning than the other options of a three-month extension or eligibility based on projected annual income. States should consider implementation of the option that best balances costs, including both administration and services, with improved health of Medicaid enrollees. PMID:26153313

42 CFR 1000.30 - Definitions specific to Medicaid.

Science.gov (United States)

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Definitions specific to Medicaid. 1000.30 Section... Medicaid. As used in connection with the Medicaid program, unless the context indicates otherwise— Applicant means an individual whose written application for Medicaid has been submitted to the agency...

42 CFR 495.310 - Medicaid provider incentive payments.

Science.gov (United States)

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Medicaid provider incentive payments. 495.310 Section 495.310 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.310 Medicaid provider incentive...

42 CFR 400.203 - Definitions specific to Medicaid.

Science.gov (United States)

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Definitions specific to Medicaid. 400.203 Section 400.203 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Medicaid. As used in connection with the Medicaid program, unless the context indicates otherwise...

Dental Care for Medicaid and CHIP Enrollees

Science.gov (United States)

... FAQs Home › Medicaid › Benefits › Dental Care Dental Care Dental Care Related Resources Learn How to Report the ... services and opportunities and challenges to obtaining care. Dental Benefits for Children in Medicaid Medicaid covers dental ...

An overview of Medicaid managed care litigation.

Science.gov (United States)

Rosenbaum, S; Teitelbaum, J; Kirby, C; Priebe, L; Klement, T

1998-11-01

Since the enactment of Medicaid in 1965, states have had the option of offering beneficiaries enrollment in managed care arrangements. With the advent of mandatory managed care reaching millions of beneficiaries (including a growing proportion of disabled recipients), the amount and scope of litigation involving Medicaid managed care plans can be expected to grow. A review of the current litigation regarding Medicaid managed care reveals two basic types of lawsuits: (1) those that challenge the practices of managed care companies under various federal and state laws that safeguard consumer rights, protect health care quality, and prohibit discrimination; and (2) suits that assert claims arising directly under the Medicaid statute and implementing regulations, as well as claims related to Constitutional safeguards that undergird the program. Lawsuits asserting claims arising under Medicaid tend to raise two basic questions: (1) the extent to which enrollment in a Medicaid managed care plan alters existing Medicaid beneficiary rights and state agency duties under federal or state Medicaid law; and (2) the extent to which managed care companies, as agents of the state, act under "color of law" (i.e., undertaking to perform official duties or acting with the imprimatur of state authority). Additionally, states might see an increase in litigation brought by prospective and current contractors who assert that they have been wrongfully denied contracts or improperly penalized for poor performance. These assertions may involve claims that are grounded in federal and state law, the Medicaid statute, and the Constitution. Moreover, in light of the consumer protection elements of the managed care reforms contained in the Balanced Budget Act, future managed care litigation may focus on the manner in which companies carry out states' obligations toward managed care enrollees. Resolution of Medicaid managed care cases involves the application of general principles of

Determination of the Interfacial Heat Transfer Coefficient in the Hot Stamping of AA7075

Directory of Open Access Journals (Sweden)

Ji Kang

2016-01-01

Full Text Available The interfacial heat transfer coefficient (IHTC is a key parameter in hot stamping processes, in which a hot blank is formed and quenched by cold dies simultaneously. The IHTC should therefore be identified and used in FE simulations to improve the accuracy of simulation results of hot stamping processes. In this work, a hot stamping simulator was designed and assembled in a Gleeble 3800 thermo-mechanical testing system and a FE model was built in PAM-STAMP to determine the IHTC values between a hot aluminium alloy 7075 blank and cold dies. The IHTC values were determined at different contact pressures under both dry and lubricated (Omega-35 conditions. In addition, a model to calculate the IHTC value at different contact pressures and area densities of lubricant was developed for the hot stamping process, which was proved to be working well with verification tests.

A rapid co-culture stamping device for studying intercellular communication

Science.gov (United States)

Hassanzadeh-Barforoushi, Amin; Shemesh, Jonathan; Farbehi, Nona; Asadnia, Mohsen; Yeoh, Guan Heng; Harvey, Richard P.; Nordon, Robert E.; Warkiani, Majid Ebrahimi

2016-10-01

Regulation of tissue development and repair depends on communication between neighbouring cells. Recent advances in cell micro-contact printing and microfluidics have facilitated the in-vitro study of homotypic and heterotypic cell-cell interaction. Nonetheless, these techniques are still complicated to perform and as a result, are seldom used by biologists. We report here development of a temporarily sealed microfluidic stamping device which utilizes a novel valve design for patterning two adherent cell lines with well-defined interlacing configurations to study cell-cell interactions. We demonstrate post-stamping cell viability of >95%, the stamping of multiple adherent cell types, and the ability to control the seeded cell density. We also show viability, proliferation and migration of cultured cells, enabling analysis of co-culture boundary conditions on cell fate. We also developed an in-vitro model of endothelial and cardiac stem cell interactions, which are thought to regulate coronary repair after myocardial injury. The stamp is fabricated using microfabrication techniques, is operated with a lab pipettor and uses very low reagent volumes of 20 μl with cell injection efficiency of >70%. This easy-to-use device provides a general strategy for micro-patterning of multiple cell types and will be important for studying cell-cell interactions in a multitude of applications.

Racial Disparities in Orthodontic Service Utilization for Medicaid-Enrolled Children: An Evaluation of the Washington Medicaid Program

Science.gov (United States)

Merritt, Jantraveus M.; Greenlee, Geoffrey; Bollen, Anne Marie; Scott, JoAnna M.; Chi, Donald L.

2016-01-01

Introduction We assess the relationship between race and orthodontic service utilization for Medicaid-enrolled children. Methods This cross-sectional study focused on 570,364 Washington Medicaid-enrolled children ages 6-19 years. The main predictor variable was self-reported race (White versus non-White). The outcome variable was orthodontic service utilization, defined as children who were pre-authorized for orthodontic treatment by Medicaid in 2012 and subsequently received orthodontic records and initiated treatment. Logistic regression models were used to test the hypothesis that non-Whites would be less likely to utilize orthodontic care than Whites. Results A total of 8,223 children were approved by Medicaid for orthodontic treatment and 7,313 received records and initiated treatment. Non-Whites were significantly more likely to utilize orthodontic care than Whites (Odds Ratio [OR]=1.18; 95% confidence interval [CI]=1.02, 1.36; p=.031). Hispanic non-White children were more likely to utilize orthodontic care than non-Hispanic White children (OR=1.42; 95% CI=1.18, 1.70; porthodontic care than White children. The Washington Medicaid program demonstrates a potential model for addressing racial disparities in orthodontic service utilization. Future research should identify mechanisms underlying these findings and continue to monitor orthodontic service utilization for minority children in Medicaid. PMID:27021456

Lessons from Early Medicaid Expansions Under Health Reform..

Data.gov (United States)

U.S. Department of Health & Human Services — Lessons from Early Medicaid Expansions Under Health Reform, Interviews with Medicaid Officials In a new study entitled Lessons from Early Medicaid Expansions Under...

75 FR 48815 - Medicaid Program and Children's Health Insurance Program (CHIP); Revisions to the Medicaid...

Science.gov (United States)

2010-08-11

... Parts 431, 447, and 457 Medicaid Program and Children's Health Insurance Program (CHIP); Revisions to... 431, 447, and 457 [CMS-6150-F] RIN 0938-AP69 Medicaid Program and Children's Health Insurance Program... final rule implements provisions from the Children's Health Insurance Program Reauthorization Act of...

Micromechanical exfoliation of two-dimensional materials by a polymeric stamp

International Nuclear Information System (INIS)

Costa, M C Ferraz da; Ribeiro, H B; Kessler, F; Souza, E A T de; Fechine, G J M

2016-01-01

In this work, an alternative technique to the traditional micromechanical exfoliation of two-dimensional materials is proposed, consisting of isolated flakes of graphite and molybdenum disulphide onto polymeric surfaces films. The set made up of polymer and flakes is fabricated by using a hot-press machine called polymeric stamp. The polymeric stamp was used to allocate flakes and also to allow the exfoliation process to take place just in one face of isolated flake. Optical microscopy, Raman spectroscopy and photoluminescence spectroscopy results showed that multilayers, bilayers and single layers of graphene and MoS 2 were obtained by using a polymeric stamp as tool for micromechanical exfoliation. These crystals were more easily found because the exfoliation process concentrates them in well-defined locations. The results prove the effectiveness of the method by embedding two-dimensional materials into polymers to fabricate fewer layers crystals in a fast, economic and clean way. (paper)

Micromechanical exfoliation of two-dimensional materials by a polymeric stamp

Science.gov (United States)

Ferraz da Costa, M. C.; Ribeiro, H. B.; Kessler, F.; de Souza, E. A. T.; Fechine, G. J. M.

2016-02-01

In this work, an alternative technique to the traditional micromechanical exfoliation of two-dimensional materials is proposed, consisting of isolated flakes of graphite and molybdenum disulphide onto polymeric surfaces films. The set made up of polymer and flakes is fabricated by using a hot-press machine called polymeric stamp. The polymeric stamp was used to allocate flakes and also to allow the exfoliation process to take place just in one face of isolated flake. Optical microscopy, Raman spectroscopy and photoluminescence spectroscopy results showed that multilayers, bilayers and single layers of graphene and MoS2 were obtained by using a polymeric stamp as tool for micromechanical exfoliation. These crystals were more easily found because the exfoliation process concentrates them in well-defined locations. The results prove the effectiveness of the method by embedding two-dimensional materials into polymers to fabricate fewer layers crystals in a fast, economic and clean way.

Diversity of Physicians’ Handwriting and Name Stamp in Chemotherapy Prescriptions: Potential Target for Fraud

Directory of Open Access Journals (Sweden)

Asiyeh Amouei

2018-02-01

Full Text Available BBackgrounds: Verification and authentication of the paper-based handwritten prescriptions is of great importance for antineoplastic medications that are good targets for forgery and fraud. Pharmacists usually investigate handwriting, signature and name stamp of prescribers to verify prescriptions in Iran. Anecdotal reports of variations in handwriting and name stamp of physicians who wrote antineoplastic prescriptions raised concerns in this regard. The aim of the study was to investigate the reported diversity and evaluate the quality of writing physician identity and required items in antineoplastic prescriptions.Methods: All insured hand-written prescriptions contained at least one antineoplastic medication and were dispensed by four main authorized community pharmacies dispensing antineoplastic medications in Tehran during one month were included. Prescriptions that were written by specialties other than oncology-related fields were excluded. Prescriptions of each physician were evaluated considering handwriting and name stamp by experienced pharmacy staff and the frequency of detected handwriting and name stamp types was recorded.Results: Of the 11022 included prescriptions, 10944 were eligible and written by 241 physicians. Median (third quartile number of physicians’ prescriptions was 17 (51. Maximum number of observed handwriting and name stamp types were eight and six respectively. High prescribers tended to have several handwriting and name stamp types.Conclusion: The observed diversity and variation in handwriting and name stamp of the physicians in antineoplastic prescriptions may facilitate the entrance of forged prescription and makes fraud detection difficult. Administrative and regulatory interventions in addition to notification of health care professionals about the observed potential might be necessary.

High Thermal Conductivity and High Wear Resistance Tool Steels for cost-effective Hot Stamping Tools

Science.gov (United States)

Valls, I.; Hamasaiid, A.; Padré, A.

2017-09-01

In hot stamping/press hardening, in addition to its shaping function, the tool controls the cycle time, the quality of the stamped components through determining the cooling rate of the stamped blank, the production costs and the feasibility frontier for stamping a given component. During the stamping, heat is extracted from the stamped blank and transported through the tool to the cooling medium in the cooling lines. Hence, the tools’ thermal properties determine the cooling rate of the blank, the heat transport mechanism, stamping times and temperature distribution. The tool’s surface resistance to adhesive and abrasive wear is also an important cost factor, as it determines the tool durability and maintenance costs. Wear is influenced by many tool material parameters, such as the microstructure, composition, hardness level and distribution of strengthening phases, as well as the tool’s working temperature. A decade ago, Rovalma developed a hot work tool steel for hot stamping that features a thermal conductivity of more than double that of any conventional hot work tool steel. Since that time, many complimentary grades have been developed in order to provide tailored material solutions as a function of the production volume, degree of blank cooling and wear resistance requirements, tool geometries, tool manufacturing method, type and thickness of the blank material, etc. Recently, Rovalma has developed a new generation of high thermal conductivity, high wear resistance tool steel grades that enable the manufacture of cost effective tools for hot stamping to increase process productivity and reduce tool manufacturing costs and lead times. Both of these novel grades feature high wear resistance and high thermal conductivity to enhance tool durability and cut cycle times in the production process of hot stamped components. Furthermore, one of these new grades reduces tool manufacturing costs through low tool material cost and hardening through readily

DOUBLE SHEAR DESIGN TO REDUCED STAMPING FORCE

Directory of Open Access Journals (Sweden)

Rudi Kurniawan Arief

2017-12-01

Full Text Available Ideally processing of part using stamping machine using only 70-80 % of available force to keep machine in good shape for a long periods. But in some certain case the force may equal to or exceed the available maximum force so the company must sent the process to another outsource company. A case found in a metal stamping company where a final product consist of 3 parts to assembly with one part exceeded the force of available machine. This part can only process in a 1000 tons machine while this company only have 2 of this machine with full workload. Sending this parts outsource will induce delivery problems because other parts are processed, assembled and paint inhouse, this also need additional transportation cost and extra supervision to ensure the quality and delivery schedule. The only exit action of this problem is by reducing the force tonnage. This paper using punch inclining method to reduce the force. The incline punch will distributed the force along the inclined surface that reduce stamping force as well. Inclined surface of punch also cause another major problems that the product becoming curved after process. This problems solved with additional flattening process that add more process cost but better than to outsource the process. Chisel type of inclining punch tip was choosen to avoid worst deformation of product. This paper will give the scientific recomendation to the company.

Does Churning in Medicaid Affect Health Care Use?

Science.gov (United States)

Roberts, Eric T.; Pollack, Craig Evan

2017-01-01

Background Transitions into and out of Medicaid, termed churning, may disrupt access to and continuity of care. Low-income, working adults who became eligible for Medicaid under the Affordable Care Act are particularly susceptible to income and employment changes that lead to churning. Objective To compare health care use among adults who do and do not churn into and out of Medicaid. Data Longitudinal data from 6 panels of the Medical Expenditure Panel Survey. Methods We used differences-in-differences regression to compare health care use when adults reenrolled in Medicaid following a loss of coverage, to utilization in a control group of continuously enrolled adults. Outcome Measures Emergency department (ED) visits, ED visits resulting in an inpatient admission, and visits to office-based providers. Results During the study period, 264 adults churned into and out of Medicaid and 627 had continuous coverage. Churning adults had an average of approximately 0.05 Medicaid-covered office-based visits per month 4 months before reenrolling in Medicaid, significantly below the rate of approximately 0.20 visits in the control group. Visits to office-based providers did not reach the control group rate until several months after churning adults had resumed Medicaid coverage. Our comparisons found no evidence of significantly elevated ED and inpatient admission rates in the churning group following reenrollment. Conclusions Adults who lose Medicaid tend to defer their use of office-based care to periods when they are insured. Although this suggests that enrollment disruptions lead to suboptimal timing of care, we do not find evidence that adults reenroll in Medicaid with elevated acute care needs. PMID:26908088

42 CFR 430.45 - Reduction of Federal Medicaid payments.

Science.gov (United States)

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Reduction of Federal Medicaid payments. 430.45 Section 430.45 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Federal Medicaid Payments § 430.45 Reduction of Federal Medicaid payments. (a) Methods of reduction. CMS...

42 CFR 495.304 - Medicaid provider scope and eligibility.

Science.gov (United States)

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Medicaid provider scope and eligibility. 495.304 Section 495.304 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.304 Medicaid provider scope and...

Determination of Proper Austenitization Temperatures for Hot Stamping of AISI 4140 Steel

Science.gov (United States)

Samadian, Pedram; Parsa, Mohammad Habibi; Shakeri, Amid

2014-04-01

High strength steels are desirable materials for use in automobile bodies in order to reduce vehicle weight and increase the safety of car passengers, but steel grades with high strength commonly show poor formability. Recently, steels with controlled microstructures and compositions are used to gain adequate strength after hot stamping while maintaining good formability during processing. In this study, microstructure evolutions and changes in mechanical properties of AISI 4140 steel sheets resulting from the hot stamping process at different austenitization temperatures were investigated. To determine the proper austenitization temperatures, the results were compared with those of the cold-worked and cold-worked plus quench-tempered specimens. Comparisons showed that the austenitization temperatures of 1000 and 1100 °C are proper for hot stamping of 3-mm-thick AISI 4140 steel sheets due to the resultant martensitic microstructure which led to the yield and ultimate tensile strength of 1.3 and 2.1 GPa, respectively. Such conditions resulted in more favorable simultaneous strength and elongation than those of hot-stamped conventional boron steels.

Association Between the 2014 Medicaid Expansion and US Hospital Finances.

Science.gov (United States)

Blavin, Fredric

2016-10-11

The Affordable Care Act expanded Medicaid eligibility for millions of low-income adults. The choice for states to expand Medicaid could affect the financial health of hospitals by decreasing the proportion of patient volume and unreimbursed expenses attributable to uninsured patients while increasing revenue from newly covered patients. To estimate the association between the Medicaid expansion in 2014 and hospital finances by assessing differences between hospitals in states that expanded Medicaid and in those states that did not expand Medicaid. Observational study with analysis of data for nonfederal general medical or surgical hospitals in fiscal years 2011 through 2014, using data from the American Hospital Association Annual Survey and the Health Care Cost Report Information System from the US Centers for Medicare & Medicaid Services. Multivariable difference-in-difference regression analyses were used to compare states with Medicaid expansion with states without Medicaid expansion. Hospitals in states that expanded Medicaid eligibility before January 2014 were excluded. Medicaid expansion in 2014, accounting for variation in fiscal year start dates. Hospital-reported information on uncompensated care, uncompensated care as a percentage of total hospital expenses, Medicaid revenue, Medicaid as a percentage of total revenue, operating margins, and excess margins. The sample included between 1200 and 1400 hospitals per fiscal year in 19 states with Medicaid expansion and between 2200 and 2400 hospitals per fiscal year in 25 states without Medicaid expansion (with sample size varying depending on the outcome measured). Expansion of Medicaid was associated with a decline of $2.8 million (95% CI, -$4.1 to -$1.6 million; P policy change on hospitals' overall finances.

Multi-cycle rolled aluminum alloy 3103 sandwiches: mechanical properties and stamp ability

Directory of Open Access Journals (Sweden)

Nosova Ekaterina

2017-01-01

Full Text Available Constructional part producing by sheet stamping of multilayer composites requires the stamping ability data. The aim of a work is to estimate mechanical properties, stamping ratio and anisotropy indexes of 2, 4, 8 and 12 layer sandwiches produced from aluminium alloy AA3103. The pieces were received by the cold rolling. Interoperation annealing was at 500°C for 1 hour. Charts of tensile strength, yield stress, elongation depending on layer thickness were composed. It was found that cold strain hardening does not disappear after annealing if the foil’s thickness become 0.4 mm and less. Microstructure analysis has shown a good contact between layers for all samples and thicker outer layers.

Limited indications of tax stamp discordance and counterfeiting on cigarette packs purchased in tobacco retailers, 97 counties, USA, 2012.

Science.gov (United States)

Lee, Joseph G L; Golden, Shelley D; Ribisl, Kurt M

2017-12-01

Increasing the per-unit cost of tobacco products is one of the strongest interventions for tobacco control. In jurisdictions with higher taxes in the U.S., however, cigarette pack litter studies show a substantial proportion of littered packs lack the appropriate tax stamp. More limited but still present counterfeiting also exists. We sought to examine the role of tobacco retailers as a source for untaxed and counterfeit products. Data collectors purchased Newport Green (menthol) or Marlboro Red cigarette packs in a national probability-based sample of tobacco retailers (in 97 counties) from June-October 2012. They made no effort to buy counterfeit or untaxed cigarettes. In this cross-sectional study, we assessed the presence, tax authority, and type (low-tech thermal vs. encrypted) of cigarette pack tax stamps; concordance of tax stamps with where the pack was purchased; and, for Marlboro cigarettes, publicly available visible indicators of counterfeiting. We purchased 2147 packs of which 2033 had tax stamps. Packs missing stamps were in states that do not require them. We found very limited discordance between store location and tax stamp(s) (tax stamps (13%). This occurred entirely with low-tech tax stamps and was not identified with encrypted tax stamps. We found no clear evidence of counterfeit products. Almost all tax stamps matched the location of purchase. Litter studies may be picking up legal tax avoidance instead of illegal tax evasion or, alternatively, purchase of illicit products requires special request by the purchaser.

45 CFR 400.94 - Determination of eligibility for Medicaid.

Science.gov (United States)

2010-10-01

... 45 Public Welfare 2 2010-10-01 2010-10-01 false Determination of eligibility for Medicaid. 400.94... Determination of eligibility for Medicaid. (a) The State must determine Medicaid and SCHIP eligibility under its Medicaid and SCHIP State plans for each individual member of a family unit that applies for medical...

27 CFR 46.116 - Issuance, distribution, and examination of special tax stamps.

Science.gov (United States)

2010-04-01

... multiple locations, TTB will send to the taxpayer's principal place of business (or principal office in the... attachment to TTB Form 5630.5t required by § 46.101(b)(2). (b) Distribution of special tax stamps for... for each location listed on the attachment to TTB Form 5630.5t and that the information on each stamp...

Kinetic and kinematic analysis of stamping impacts during simulated rucking in rugby union.

Science.gov (United States)

Oudshoorn, Bodil Y; Driscoll, Heather F; Dunn, Marcus; James, David

2018-04-01

Laceration injuries account for up to 23% of injuries in rugby union. They are frequently caused by studded footwear as a result of a player stamping onto another player during the ruck. Little is known about the kinetics and kinematics of rugby stamping impacts; current test methods assessing laceration injury risk of stud designs therefore lack informed test parameters. In this study, twelve participants stamped on an anthropomorphic test device in a one-on-one simulated ruck setting. Velocity and inclination angle of the foot prior to impact was determined from high-speed video footage. Total stamping force and individual stud force were measured using pressure sensors. Mean foot inbound velocity was 4.3 m ∙ s -1 (range 2.1-6.3 m ∙ s -1 ). Mean peak total force was 1246 N and mean peak stud force was 214 N. The total mean effective mass during stamping was 6.6 kg (range: 1.6-13.5 kg) and stud effective mass was 1.2 kg (range: 0.5-2.9 kg). These results provide representative test parameters for mechanical test devices designed to assess laceration injury risk of studded footwear for rugby union.

A Fully Automated and Robust Method to Incorporate Stamping Data in Crash, NVH and Durability Analysis

Science.gov (United States)

Palaniswamy, Hariharasudhan; Kanthadai, Narayan; Roy, Subir; Beauchesne, Erwan

2011-08-01

Crash, NVH (Noise, Vibration, Harshness), and durability analysis are commonly deployed in structural CAE analysis for mechanical design of components especially in the automotive industry. Components manufactured by stamping constitute a major portion of the automotive structure. In CAE analysis they are modeled at a nominal state with uniform thickness and no residual stresses and strains. However, in reality the stamped components have non-uniformly distributed thickness and residual stresses and strains resulting from stamping. It is essential to consider the stamping information in CAE analysis to accurately model the behavior of the sheet metal structures under different loading conditions. Especially with the current emphasis on weight reduction by replacing conventional steels with aluminum and advanced high strength steels it is imperative to avoid over design. Considering this growing need in industry, a highly automated and robust method has been integrated within Altair Hyperworks® to initialize sheet metal components in CAE models with stamping data. This paper demonstrates this new feature and the influence of stamping data for a full car frontal crash analysis.

Medicaid prospective payment: Case-mix increase

Science.gov (United States)

Baker, Samuel L.; Kronenfeld, Jennie J.

1990-01-01

South Carolina Medicaid implemented prospective payment by diagnosis-related group (DRG) for inpatient care. The rate of complications among newborns and deliveries doubled immediately. The case-mix index for newborns increased 66.6 percent, which increased the total Medicaid hospital expenditure 5.5 percent. Outlier payments increased total expenditure further. DRG distribution change among newborns has a large impact on spending because newborn complication DRGs have high weights. States adopting a DRG-based payment system for Medicaid should anticipate a greater increase in case mix than Medicare experienced. PMID:10113463

Characterization of thermoplastic composites for hot stamp forming

NARCIS (Netherlands)

Rietman, Bert; Grouve, Wouter; Akkerman, Remko

2014-01-01

This paper describes state-of-the-art characterization methods for thermoplastic composites at high processing temperature and provides a few examples of application in simulations of the hot stamp forming process.

The Economic Impact of Medicaid Expansion on Pennsylvania.

Science.gov (United States)

Price, Carter C; Donohue, Julie M; Saltzman, Evan; Woods, Dulani; Eibner, Christine

2013-01-01

The Affordable Care Act is a substantial reform of the U.S. health care insurance system. Using the RAND COMPARE model, researchers assessed the act's potential economic effects on Pennsylvania, factoring in an optional expansion of Medicaid, and found the state would enjoy significant net benefits. With or without the expansion of Medicaid, the act will increase insurance coverage to hundreds of thousands of Pennsylvanians, but the COMPARE model estimates that the expansion of Medicaid eligibility would cover an additional 350,000 people and bring more than $2 billion in federal spending into the state annually than if the state did not expand. Should the state expand Medicaid, the additional spending will add more than $3 billion a year to the state's GDP and support 35,000 jobs. But Medicaid expansion is not without cost for the state; the estimated cumulative effect on Pennsylvania's Medicaid spending will be $180 million higher with the expansion than without between 2014 and 2020. Substantial reductions in uncompensated care costs for hospitals are possible even without expansion, but savings to hospitals for uncompensated care funding are even larger with the Medicaid expansion, amounting to $550 million or more each year.

Fabrication of Ni stamp with high aspect ratio, two-leveled, cylindrical microstructures using dry etching and electroplating

DEFF Research Database (Denmark)

Petersen, Ritika Singh; Keller, Stephan Sylvest; Hansen, Ole

2015-01-01

obtained by defining a reservoir and a separating trench with different depths of 85 and 125 μm, respectively, in a single embossing step. The fabrication of the required two leveled stamp is done using a modified DEEMO (dry etching, electroplating and molding) process. Dry etching using the Bosch process...... and electroplating are optimized to obtain a stamp with smooth stamp surfaces and a positive sidewall profile. Using this stamp, hot embossing is performed successfully with excellent yield and high replication fidelity....

Expanding Medicaid Access without Expanding Medicaid: Why Did Some Nonexpansion States Continue the Primary Care Fee Bump?

Science.gov (United States)

Wilk, Adam S; Evans, Leigh C; Jones, David K

2018-02-01

Six states that have rejected the Patient Protection and Affordable Care Act's (ACA) Medicaid expansion nonetheless extended the primary care "fee bump," by which the federal government increased Medicaid fees for primary care services up to 100 percent of Medicare fees during 2013-14. We conducted semistructured interviews with leaders in five of these states, as well as in three comparison states, to examine why they would continue a provision of the ACA that moderately expands access at significant state expense while rejecting the expansion and its large federal match, focusing on relevant economic, political, and procedural factors. We found that fee bump extension proposals were more successful where they were dissociated from major national policy debates, actionable with the input of relatively few stakeholder entities, and well aligned with preexisting policy-making structures and decision trends. Republican proposals to cap or reduce federal funding for Medicaid, if enacted, would compel states to contain program costs. In this context, states' established decision-making processes for updating Medicaid fee schedules, which we elucidate in this study, may shape the future of the Medicaid program. Copyright © 2018 by Duke University Press 2018.

75 FR 69037 - Medicaid Program; Recovery Audit Contractors

Science.gov (United States)

2010-11-10

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Part 455 [CMS-6034-P] RIN 0938-AQ19 Medicaid Program; Recovery Audit Contractors AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Proposed rule. SUMMARY: This proposed rule would provide guidance to...

State Medicaid Coverage, ESRD Incidence, and Access to Care

Science.gov (United States)

Goldstein, Benjamin A.; Hall, Yoshio N.; Mitani, Aya A.; Winkelmayer, Wolfgang C.

2014-01-01

The proportion of low-income nonelderly adults covered by Medicaid varies widely by state. We sought to determine whether broader state Medicaid coverage, defined as the proportion of each state’s low-income nonelderly adult population covered by Medicaid, associates with lower state-level incidence of ESRD and greater access to care. The main outcomes were incidence of ESRD and five indicators of access to care. We identified 408,535 adults aged 20–64 years, who developed ESRD between January 1, 2001, and December 31, 2008. Medicaid coverage among low-income nonelderly adults ranged from 12.2% to 66.0% (median 32.5%). For each additional 10% of the low-income nonelderly population covered by Medicaid, there was a 1.8% (95% confidence interval, 1.0% to 2.6%) decrease in ESRD incidence. Among nonelderly adults with ESRD, gaps in access to care between those with private insurance and those with Medicaid were narrower in states with broader coverage. For a 50-year-old white woman, the access gap to the kidney transplant waiting list between Medicaid and private insurance decreased by 7.7 percentage points in high (>45%) versus low (Medicaid coverage states. Similarly, the access gap to transplantation decreased by 4.0 percentage points and the access gap to peritoneal dialysis decreased by 3.8 percentage points in high Medicaid coverage states. In conclusion, states with broader Medicaid coverage had a lower incidence of ESRD and smaller insurance-related access gaps. PMID:24652791

Cooling Systems Design in Hot Stamping Tools by a Thermal-Fluid-Mechanical Coupled Approach

Directory of Open Access Journals (Sweden)

Tao Lin

2014-06-01

Full Text Available Hot stamping tools with cooling systems are the key facilities for hot stamping process of Ultrahigh strength steels (UHSS in automotive industry. Hot stamping tools have significant influence on the final microstructure and properties of the hot stamped parts. In serials production, the tools should be rapidly cooled by cooling water. Hence, design of hot stamping tools with cooling systems is important not only for workpieces of good quality but also for the tools with good cooling performance and long life. In this paper, a new multifield simulation method was proposed for the design of hot stamping tools with cooling system. The deformation of the tools was also analyzed by this method. Based on MpCCI (Mesh-based parallel Code Coupling Interface, thermal-fluid simulation and thermal-fluid-mechanical coupled simulation were performed. Subsequently, the geometrical parameters of the cooling system are investigated for the design. The results show that, both the distance between the ducts and the distance between the ducts and the tools loaded contour have significant influence on the quenching effect. And better quenching effect can be achieved with the shorter distance from the tool surface and with smaller distance between ducts. It is also shown that, thermal expansion is the main reason for deformation of the hot forming tools, which causes the distortion of the cooling ducts, and the stress concentration at corner of the ducts.

42 CFR 493.1809 - Limitation on Medicaid payment.

Science.gov (United States)

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Limitation on Medicaid payment. 493.1809 Section 493.1809 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Limitation on Medicaid payment. As provided in section 1902(a)(9)(C) of the Act, payment for laboratory...

Expansion of Medicaid Covered Smoking Cessation Services

Data.gov (United States)

U.S. Department of Health & Human Services — Expansionof Medicaid Covered Smoking Cessation Services - Maternal Smoking and Birth Outcomes. To assess whether Medicaid coverage of smoking cessation services...

Limited indications of tax stamp discordance and counterfeiting on cigarette packs purchased in tobacco retailers, 97 counties, USA, 2012

Directory of Open Access Journals (Sweden)

Joseph G.L. Lee

2017-12-01

Full Text Available Increasing the per-unit cost of tobacco products is one of the strongest interventions for tobacco control. In jurisdictions with higher taxes in the U.S., however, cigarette pack litter studies show a substantial proportion of littered packs lack the appropriate tax stamp. More limited but still present counterfeiting also exists. We sought to examine the role of tobacco retailers as a source for untaxed and counterfeit products. Data collectors purchased Newport Green (menthol or Marlboro Red cigarette packs in a national probability-based sample of tobacco retailers (in 97 counties from June–October 2012. They made no effort to buy counterfeit or untaxed cigarettes. In this cross-sectional study, we assessed the presence, tax authority, and type (low-tech thermal vs. encrypted of cigarette pack tax stamps; concordance of tax stamps with where the pack was purchased; and, for Marlboro cigarettes, publicly available visible indicators of counterfeiting. We purchased 2147 packs of which 2033 had tax stamps. Packs missing stamps were in states that do not require them. We found very limited discordance between store location and tax stamp(s (<1%. However, a substantial minority of cigarette packs had damaged tax stamps (13%. This occurred entirely with low-tech tax stamps and was not identified with encrypted tax stamps. We found no clear evidence of counterfeit products. Almost all tax stamps matched the location of purchase. Litter studies may be picking up legal tax avoidance instead of illegal tax evasion or, alternatively, purchase of illicit products requires special request by the purchaser. Keywords: Taxes, Smoking, Tobacco products, Government regulation, Government

42 CFR 455.232 - Medicaid integrity audit program contractor functions.

Science.gov (United States)

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Medicaid integrity audit program contractor functions. 455.232 Section 455.232 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PROGRAM INTEGRITY: MEDICAID Medicaid...

Soil Temperature and Moisture Profile (STAMP) System Handbook

Energy Technology Data Exchange (ETDEWEB)

Cook, David R. [Argonne National Lab. (ANL), Argonne, IL (United States)

2016-11-01

The soil temperature and moisture profile system (STAMP) provides vertical profiles of soil temperature, soil water content (soil-type specific and loam type), plant water availability, soil conductivity, and real dielectric permittivity as a function of depth below the ground surface at half-hourly intervals, and precipitation at one-minute intervals. The profiles are measured directly by in situ probes at all extended facilities of the SGP climate research site. The profiles are derived from measurements of soil energy conductivity. Atmospheric scientists use the data in climate models to determine boundary conditions and to estimate the surface energy flux. The data are also useful to hydrologists, soil scientists, and agricultural scientists for determining the state of the soil. The STAMP system replaced the SWATS system in early 2016.

Effects of surface coating on weld growth of resistance spot-welded hot-stamped boron steels

International Nuclear Information System (INIS)

Ji, Chang Wook; Lee, Hyun Ju; Kim, Yang Do; Jo, Il Guk; Choi, Il Dong; Park, Yeong Do

2014-01-01

Aluminum-silicon-based and zinc-based metallic coatings have been widely used for hot-stamped boron steel in automotive applications. In this study, resistance spot weldability was explored by investigating the effects of the properties of metallic coating layers on heat development and nugget growth during resistance spot welding. In the case of the aluminum-silicon-coated hot-stamped boron steel, the intermetallic coating transformed into a liquid film that covered the faying interface. A wide, weldable current range was obtained with slow heat development because of low contact resistance and large current passage. In the case of the zinc-coated hot-stamped boron steel, a buildup of liquid and vapor formation under large vapor pressure was observed at the faying interface because of the high contact resistance and low vaporization temperature of the intermetallic layers. With rapid heat development, the current passage was narrow because of the limited continuous layer at the faying interface. A more significant change in nugget growth was observed in the zinc coated hot-stamped boron steel than in the aluminum-silicon-coated hot-stamped boron steel.

Health Care Financing Administration--Medicaid program; Medicaid management information systems. Final rule.

Science.gov (United States)

1980-03-05

These regulations set forth a new procedure to improve Medicaid management by explicitly authorizing HCFA to expand or revise State Medicaid Management Information Systems (MMIS) as necessary to meet program needs. Under this procedure, HCFA will publish major new requirements for comment before deciding to adopt them, and will provide increased Federal matching and reasonable phase-in time for their implementation. HCFA will also periodically review ongoing systems to determine whether all system requirements and performance standards are being met and may reduce the level of Federal matching for those MMIS systems which do not meet prescribed standards.

Medicaid Financial Management Data – National Totals

Data.gov (United States)

U.S. Department of Health & Human Services — This dataset reports summary state-by-state total expenditures by program for the Medicaid Program, Medicaid Administration and CHIP programs. These state...

STAMP model and its application prospect in DCS safety analysis of nuclear power plant

International Nuclear Information System (INIS)

Yang Xiaohua; Liu Jie; Liu Zhaohui; Liu Hua; Yu Tonglan

2013-01-01

The application of DCS (Digit Control System) is a certain trend for the development of nuclear power. DCS not only improves the control capability of nuclear power system, but also increases the complexity of the system. Traditional safety analysis techniques based on event-chain model are facing challenges. In order to improve the safety performance of nuclear power DCS, the latest research achievement in the field of safety engineering should be focused, studied and applied into nuclear power safety. This paper introduces a new safety analysis model named STAMP (Systems-Theoretic Accident Modeling and Processes) based on the system theory, analyzes its advantages and disadvantages compared with the traditional ones, and explains the basic steps of STPA (STAMP-Based Hazard Analysis) technology. Finally, according to the application status of STAMP at home and abroad, it prospects the development of STAMP in China's nuclear power safety. (authors)

Process control for sheet-metal stamping process modeling, controller design and shop-floor implementation

CERN Document Server

Lim, Yongseob; Ulsoy, A Galip

2014-01-01

Process Control for Sheet-Metal Stamping presents a comprehensive and structured approach to the design and implementation of controllers for the sheet metal stamping process. The use of process control for sheet-metal stamping greatly reduces defects in deep-drawn parts and can also yield large material savings from reduced scrap. Sheet-metal forming is a complex process and most often characterized by partial differential equations that are numerically solved using finite-element techniques. In this book, twenty years of academic research are reviewed and the resulting technology transitioned to the industrial environment. The sheet-metal stamping process is modeled in a manner suitable for multiple-input multiple-output control system design, with commercially available sensors and actuators. These models are then used to design adaptive controllers and real-time controller implementation is discussed. Finally, experimental results from actual shopfloor deployment are presented along with ideas for further...

Can Medicaid Claims Validly Ascertain Foster Care Status?

Science.gov (United States)

Raghavan, Ramesh; Brown, Derek S; Allaire, Benjamin T

2017-08-01

Medicaid claims have been used to identify populations of children in foster care in the current literature; however, the ability of such an approach to validly ascertain a foster care population is unknown. This study linked children in the National Survey of Child and Adolescent Well-Being-I to their Medicaid claims from 36 states using their Social Security numbers. Using this match, we examined discordance between caregiver report of foster care placement and the foster care eligibility code contained in the child's Medicaid claims. Only 73% of youth placed in foster care for at least a year displayed a Medicaid code for foster care eligibility. Half of all youth coming into contact with child welfare displayed discordance between caregiver report and Medicaid claims. Children with emergency department utilization, and those in primary care case management health insurance arrangements, had the highest odds of accurate ascertainment. The use of Medicaid claims to identify a cohort of children in foster care results in high rates of underascertainment. Supplementing administrative data with survey data is one way to enhance validity of ascertainment.

Medicaid expenditures for children living with smokers

Directory of Open Access Journals (Sweden)

Levy Douglas E

2011-05-01

Full Text Available Abstract Background Children's exposure to secondhand smoke is associated with increased morbidity. We estimated Medicaid expenditures for children living with smokers compared to those living with no smokers in the United States. Methods Data were overall and service-specific (i.e., inpatient, ambulatory, emergency department, prescription drug, and dental annual Medicaid expenditures for children 0-11 years old from the 2000-2007 Medical Expenditures Panel Surveys. Smokers' presence in households was determined by adult respondents' self reports. There were 25,835 person-years of observation. We used multivariate analyses to adjust for child, parent, and geographic characteristics. Results Children with Medicaid expenditures were nearly twice as likely to live with a smoker as other children in the U.S. population. Adjusted analyses revealed no detectable differences in children's overall Medicaid expenditures by presence of smokers in the household. Medicaid children who lived with smokers on average had $10 (95% CI $3, $18 higher emergency department expenditures per year than those living with no smokers. Conclusions Living with at least one smoker (a proxy for secondhand smoke exposure is unrelated to children's overall short-term Medicaid expenditures, but has a modest impact on emergency department expenditures. Additional research is necessary to understand the relationship between secondhand smoke exposure and long-term health and economic outcomes.

Medicare-Medicaid Enrollee Profiles (State and National)

Data.gov (United States)

U.S. Department of Health & Human Services — Today there are over 10 million Medicare-Medicaid enrollees in the United States.To provide a greater understanding of the Medicare-Medicaid enrollee population, the...

42 CFR 495.320 - FFP for payments to Medicaid providers.

Science.gov (United States)

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false FFP for payments to Medicaid providers. 495.320 Section 495.320 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.320 FFP for payments to Medicaid...

Medicaid CHIP Environmental Scanning and Program Char...

Data.gov (United States)

U.S. Department of Health & Human Services — ESPC development is sponsored by the CMS Center for Medicare and Medicaid Innovation in partnership with the Center for Medicaid and CHIP Services (CMCS) under the...

Medicaid Analytic eXtract (MAX) General Information

Data.gov (United States)

U.S. Department of Health & Human Services — The Medicaid Analytic eXtract (MAX) data is a set of person-level data files on Medicaid eligibility, service utilization, and payments. The MAX data are created to...

Methods University Health System Can Use to Expand Medicaid Coverage to Uninsured Poor Parents with Medicaid Eligible Children: Policy Analysis

National Research Council Canada - National Science Library

McMahon, III, Robert T

2006-01-01

Bexar County, low-income, uninsured parents with Medicaid-eligible children have been negatively impacted by reductions in Medicaid eligibility standards made by the Texas State Legislature in 2003...

77 FR 26827 - Medicaid Program; Community First Choice Option

Science.gov (United States)

2012-05-07

... Medicare & Medicaid Services 42 CFR Part 441 Medicaid Program; Community First Choice Option; Final Rule #0... [CMS-2337-F] RIN 0938-AQ35 Medicaid Program; Community First Choice Option AGENCY: Centers for Medicare... Affordable Care Act, which establishes a new State option to provide home and community-based attendant...

Medicaid Contradictions: Adding, Subtracting, and Redeterminations in Illinois.

Science.gov (United States)

Koetting, Michael

2016-04-01

States are required to conduct annual Medicaid redeterminations. How these redeterminations are undertaken is crucial to determining the nature of Medicaid coverage. There can be wide variations in the proportion of clients disenrolled, with potentially large numbers of people disenrolled each year. This case study of Illinois Medicaid shows how, as the Affordable Care Act added people, redeterminations were taking people off the rolls-about 25 percent of all Medicaid clients were disenrolled in one year. Many of these people were no longer eligible, but it appears that a larger number were in fact eligible but simply failed to comply with administrative requirements in a timely way. Balancing between the two imperatives of program integrity and continuity of care is a difficult act for Medicaid programs. The Illinois experience also illustrates impacts on information technology and outsourcing of eligibility functions, not to mention budget considerations. Copyright © 2016 by Duke University Press.

Global city aspirations, graduated citizenship and public housing: analysing the consumer citizenships of neoliberalism

OpenAIRE

Dallas Rogers; Michael Darcy

2014-01-01

Global city discourses rearticulate the relationships between the state, urban space and the global economy. At the local level, global city reconfigurations stamp the mark of a global economic order onto local citizenship practices. Public housing is a legacy of specific national (welfare) states where citizenship rights arose from territorially bound constitutional discourses, and is incompatible in its current form with the consumer-based rights and responsibilities of a global economic or...

EFFECTS OF EBT CUSTOMER SERVICE WAIVERS ON FOOD STAMP RECIPIENTS: EXECUTIVE SUMMARY

OpenAIRE

Kirlin, John A.; Logan, Christopher

2002-01-01

Most State agencies are now using electronic benefits transfer (EBT) systems to issue food stamp benefits. To promote operational efficiency, some States have received waivers of certain rules governing EBT use. An exploratory study was conducted to ascertain the effects of these waivers on food stamp recipients. The results show that two of the waivers-those allowing recipients to select their own personal identification numbers and to receive EBT training by mail rather than in person-cause...

42 CFR 431.630 - Coordination of Medicaid with QIOs.

Science.gov (United States)

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Coordination of Medicaid with QIOs. 431.630 Section 431.630 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... With Other Agencies § 431.630 Coordination of Medicaid with QIOs. (a) The State plan may provide for...

76 FR 10735 - Medicaid Program; Community First Choice Option

Science.gov (United States)

2011-02-25

... for Medicare & Medicaid Services 42 CFR Part 441 Medicaid Program; Community First Choice Option... Part 441 [CMS-2337-P] RIN 0938-AQ35 Medicaid Program; Community First Choice Option AGENCY: Centers for... Section 2401 of the Affordable Care Act (ACA) which establishes a new State option to provide home and...

Trends in emergency Medicaid expenditures for recent and undocumented immigrants.

Science.gov (United States)

DuBard, C Annette; Massing, Mark W

2007-03-14

Undocumented immigrants and legal immigrants who have been in the United States less than 5 years are excluded from Medicaid eligibility, with the exception of limited coverage for emergency conditions (Emergency Medicaid). New immigrant population growth has been rapid in recent years, but little is known about use of health services by this group or the conditions for which Emergency Medicaid coverage has been applied. To describe Emergency Medicaid use by recent and undocumented immigrants including patient characteristics, diagnoses, and recent spending trends in North Carolina, a state with a rapidly increasing population of undocumented immigrants. Descriptive analysis of North Carolina Medicaid administrative data for all claims reimbursed under Emergency Medicaid eligibility criteria 2001 through 2004 in North Carolina, a state with high immigration from Mexico and Latin America. Patients are recent and undocumented immigrants who meet categorical and income criteria for Medicaid coverage, but are excluded from full coverage due to legal status. Patient characteristics, hospitalizations, diagnoses, and Medicaid spending for emergency care. A total of 48,391 individuals received services reimbursed under Emergency Medicaid during the 4-year period of this study. The patient population was 99% undocumented, 93% Hispanic, 95% female, and 89% in the 18- to 40-year age group. Total spending increased by 28% from 2001 through 2004, with more rapid spending increases among elderly (98%) and disabled (82%) patients. In 2004, childbirth and complications of pregnancy accounted for 82% of spending and 91% of hospitalizations. Injury, renal failure, gastrointestinal disease, and cardiovascular conditions were also prevalent. Childbirth and complications of pregnancy account for the majority of Emergency Medicaid spending for undocumented immigrants in North Carolina. Spending for elderly and disabled patients, however, is increasing at a faster rate. Among nonpregnant

Senate, 59-40, defeats move to strike limits on Medicaid abortion coverage.

Science.gov (United States)

1993-10-05

On September 24 1993, the US Senate voted to limit access to abortion services for poor women under Medicaid to cases of rape, incest, or where pregnancy poses a risk to a woman's health. The US House of Representatives had earlier adopted a similar amendment, so now the bill will be sent to the President. The original amendment limited abortion access under Medicaid to only poor women whose life was endangered. Its sponsor proposed to expand coverage to cases of rape and incest based on pragmatic political grounds and knowing that this expansion would include fewer than 100 abortions. Abortion rights groups considered this 1993 expansion of the amendment as a step toward restoring real equity in access to abortion. Nevertheless, like the antiabortion groups, they do not consider it progress. The 5 female Senators vowed to fight to obtain full abortion coverage under Medicaid. The also pointed out to their male colleagues that this amendment discriminates against poor women. Many senators voted for the amendment because they chose the lesser of 2 evils. Many people are concerned that this bill indicates how Congress will treat poor women when health care reform legislation arrives and its concern for all women's right to access to abortion services under government-sponsored programs. More than 40 Senators can clearly see the difference between direct federal funding of abortion and other forms of government involvement. Further, Congress did approve the bill granting federal employees access to abortion services, but it passed by only 1 vote. Abortion rights proponents and abortion opponents should consider these aforementioned facts when preparing for the debate over abortion coverage under health care reform.

Development of a Medicaid Behavioral Health Case-Mix Model

Science.gov (United States)

Robst, John

2009-01-01

Many Medicaid programs have either fully or partially carved out mental health services. The evaluation of carve-out plans requires a case-mix model that accounts for differing health status across Medicaid managed care plans. This article develops a diagnosis-based case-mix adjustment system specific to Medicaid behavioral health care. Several…

42 CFR 456.506 - Waiver options for Medicaid agency.

Science.gov (United States)

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Waiver options for Medicaid agency. 456.506 Section 456.506 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... options for Medicaid agency. (a) The agency may apply for a waiver at any time it has the procedures...

Stamp design effect on 100 nm feature size for 8 inch NanoImprint lithography

International Nuclear Information System (INIS)

Landis, S; Chaix, N; Gourgon, C; Perret, C; Leveder, T

2006-01-01

Sub-100 nm resolution on a 200 mm silicon stamp has been hot embossed into commercial Sumitomo NEB 22 resist. A single pattern, exposed with electron beam lithography, has been considered to define the stamp and thus make it possible to point out the impact of stamp design on the printing. These results may be considered as a first attempt to define rules to solve the proximity printing effects (PPEs). Moreover, a large range of initial resist thickness, from 56 to 506 nm, has been spin coated to assess the effect of polymer flow properties for the stamp cavity filling and the printed defects. A detailed analysis of the printed resist in dense hole patterns showed that the application volume conservation is enough to calculate the residual layer thickness as the height of the printed resist feature. Good accordance has been obtained between the theoretical approach and experimental results. Moreover, the impact of the pattern symmetry breakdown on mould deformation is clearly shown in this paper in the printed areas as well as in the unprinted areas

Stamping of Thin-Walled Structural Components with Magnesium Alloy AZ31 Sheets

International Nuclear Information System (INIS)

Chen, F.-K.; Chang, C.-K.

2005-01-01

In the present study, the stamping process for manufacturing cell phone cases with magnesium alloy AZ31 sheets was studied using both the experimental approach and the finite element analysis. In order to determine the proper forming temperature and set up a fracture criterion, tensile tests and forming limit tests were first conducted to obtain the mechanical behaviors of AZ31 sheets at various elevated temperatures. The mechanical properties of Z31 sheets obtained from the experiments were then adopted in the finite element analysis to investigate the effects of the process parameters on the formability of the stamping process of cell phone cases. The finite element simulation results revealed that both the fracture and wrinkle defects could not be eliminated at the same time by adjusting blank-holder force or blank size. A drawbead design was then performed using the finite element simulations to determine the size and the location of drawbead required to suppress the wrinkle defect. An optimum stamping process, including die geometry, forming temperature, and blank dimension, was then determined for manufacturing the cell phone cases. The finite element analysis was validated by the good agreement between the simulation results and the experimental data. It confirms that the cell phone cases can be produced with magnesium alloy AZ31 sheet by the stamping process at elevated temperatures

Challenges in using medicaid claims to ascertain child maltreatment.

Science.gov (United States)

Raghavan, Ramesh; Brown, Derek S; Allaire, Benjamin T; Garfield, Lauren D; Ross, Raven E; Hedeker, Donald

2015-05-01

Medicaid data contain International Classification of Diseases, Clinical Modification (ICD-9-CM) codes indicating maltreatment, yet there is a little information on how valid these codes are for the purposes of identifying maltreatment from health, as opposed to child welfare, data. This study assessed the validity of Medicaid codes in identifying maltreatment. Participants (n = 2,136) in the first National Survey of Child and Adolescent Well-Being were linked to their Medicaid claims obtained from 36 states. Caseworker determinations of maltreatment were compared with eight sets of ICD-9-CM codes. Of the 1,921 children identified by caseworkers as being maltreated, 15.2% had any relevant ICD-9-CM code in any of their Medicaid files across 4 years of observation. Maltreated boys and those of African American race had lower odds of displaying a maltreatment code. Using only Medicaid claims to identify maltreated children creates validity problems. Medicaid data linkage with other types of administrative data is required to better identify maltreated children. © The Author(s) 2014.

42 CFR 456.372 - Medicaid agency review of need for admission.

Science.gov (United States)

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Medicaid agency review of need for admission. 456.372 Section 456.372 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND... Medicaid agency review of need for admission. Medical and other professional personnel of the Medicaid...

Financial Performance of Health Plans in Medicaid Mana...

Data.gov (United States)

U.S. Department of Health & Human Services — This study assesses the financial performance of health plans that enroll Medicaid members across the key plan traits, specifically Medicaid dominant, publicly...

Recent Health Care Use and Medicaid Entry of Medicare Beneficiaries.

Science.gov (United States)

Keohane, Laura M; Trivedi, Amal N; Mor, Vincent

2017-10-01

To examine the relationship between Medicaid entry and recent health care use among Medicare beneficiaries. We identified Medicare beneficiaries without full Medicaid or use of hospital or nursing home services in 2008 (N = 2,163,387). A discrete survival analysis estimated beneficiaries' monthly likelihood of entry into the full Medicaid program between January 2009 and June 2010. During the 18-month study period, Medicaid entry occurred for 1.1% and 3.7% of beneficiaries who aged into Medicare or originally qualified for Medicare due to disability, respectively. Among beneficiaries who aged into Medicare, 49% of new Medicaid participants had no use of inpatient, skilled nursing facility, or nursing home services during the study period. Individuals who recently used inpatient, skilled nursing facility or nursing home services had monthly rates of 1.9, 14.0, and 38.1 new Medicaid participants per 1,000 beneficiaries, respectively, compared with 0.4 new Medicaid participants per 1,000 beneficiaries with no recent use of these services. Although recent health care use predicted greater likelihood of Medicaid entry, half of new Medicaid participants used no hospital or nursing home care during the study period. These patterns should be considered when designing and evaluating interventions to reform health care delivery for dual-eligible beneficiaries. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Access to Care for Medicare-Medicaid Dually Eligible Beneficiaries: The Role of State Medicaid Payment Policies.

Science.gov (United States)

Zheng, Nan Tracy; Haber, Susan; Hoover, Sonja; Feng, Zhanlian

2017-12-01

Medicaid programs are not required to pay the full Medicare coinsurance and deductibles for Medicare-Medicaid dually eligible beneficiaries. We examined the association between the percentage of Medicare cost sharing paid by Medicaid and the likelihood that a dually eligible beneficiary used evaluation and management (E&M) services and safety net provider services. Medicare and Medicaid Analytic eXtract enrollment and claims data for 2009. Multivariate analyses used fee-for-service dually eligible and Medicare-only beneficiaries in 20 states. A comparison group of Medicare-only beneficiaries controlled for state factors that might influence utilization. Paying 100 percent of the Medicare cost sharing compared to 20 percent increased the likelihood (relative to Medicare-only) that a dually eligible beneficiary had any E&M visit by 6.4 percent. This difference in the percentage of cost sharing paid decreased the likelihood of using safety net providers, by 37.7 percent for federally qualified health centers and rural health centers, and by 19.8 percent for hospital outpatient departments. Reimbursing the full Medicare cost-sharing amount would improve access for dually eligible beneficiaries, although the magnitude of the effect will vary by state and type of service. © Health Research and Educational Trust.

Acceptance of New Medicaid Patients by Primary Care Physicians and Experiences with Physician Availability among Children on Medicaid or the Children's Health Insurance Program

Science.gov (United States)

Decker, Sandra L

2015-01-01

Objective To estimate the relationship between physicians' acceptance of new Medicaid patients and access to health care. Data Sources The National Ambulatory Medical Care Survey (NAMCS) Electronic Health Records Survey and the National Health Interview Survey (NHIS) 2011/2012. Study Design Linear probability models estimated the relationship between measures of experiences with physician availability among children on Medicaid or the Children's Health Insurance Program (CHIP) from the NHIS and state-level estimates of the percent of primary care physicians accepting new Medicaid patients from the NAMCS, controlling for other factors. Principal Findings Nearly 16 percent of children with a significant health condition or development delay had a doctor's office or clinic indicate that the child's health insurance was not accepted in states with less than 60 percent of physicians accepting new Medicaid patients, compared to less than 4 percent in states with at least 75 percent of physicians accepting new Medicaid patients. Adjusted estimates and estimates for other measures of access to care were similar. Conclusions Measures of experiences with physician availability for children on Medicaid/CHIP were generally good, though better in states where more primary care physicians accepted new Medicaid patients. PMID:25683869

MECHANICAL VIBRATION INHIBITS OSTEOCLAST FORMATION BY REDUCING DC-STAMP RECEPTOR EXPRESSION IN OSTEOCLAST PRECURSOR CELLS

Science.gov (United States)

Kulkarni, R.N.; Voglewede, P.A.; Liu, D.

2014-01-01

It is well known that physical inactivity leads to loss of muscle mass, but it also causes bone loss. Mechanistically, osteoclastogenesis and bone resorption have recently been shown to be regulated by vibration. However, the underlying mechanism behind the inhibition of osteoclast formation is yet unknown. Therefore, we investigated whether mechanical vibration of osteoclast precursor cells affects osteoclast formation by the involvement of fusion-related molecules such as dendritic cell-specific transmembrane protein (DC-STAMP), and P2X7 receptor (P2X7R). RAW264.7 (a murine osteoclastic-like cell line) cells were treated with 20 ng/ml receptor activator of NF-κB ligand (RANKL). For 3 consecutive days, the cells were subjected to 1 hour of mechanical vibration with 20 µm displacement at a frequency of 4 Hz and compared to the control cells that were treated under the same condition but without the vibration. After 5 days of culture, osteoclast formation was determined. Gene expression of DC-STAMP and P2X7R by RAW264.7 cells were determined after 1 hour mechanical vibration, while protein production of the DC-STAMP was determined after 6 hours of post incubation after vibration. As a result, mechanical vibration of RAW264.7 cells inhibited the formation of osteoclasts. Vibration down-regulated DC-STAMP gene expression by 1.6-fold in the presence of RANKL and by 1.4-fold in the absence of RANKL. Additionally, DC-STAMP protein production was also down-regulated by 1.4-fold in the presence of RANKL and by 1.2-fold in the absence of RANKL in RAW264.7 cells in response to mechanical vibration. However, vibration did not affect P2X7R gene expression. Mouse anti-DC-STAMP antibody inhibited osteoclast formation in the absence of vibration. Our results suggest that mechanical vibration of osteoclast precursor cells reduce DC-STAMP expression in osteoclast precursor cells leading to the inhibition of osteoclast formation. PMID:23994170

Mechanical vibration inhibits osteoclast formation by reducing DC-STAMP receptor expression in osteoclast precursor cells.

Science.gov (United States)

Kulkarni, Rishikesh N; Voglewede, Philip A; Liu, Dawei

2013-12-01

It is well known that physical inactivity leads to loss of muscle mass, but it also causes bone loss. Mechanistically, osteoclastogenesis and bone resorption have recently been shown to be regulated by vibration. However, the underlying mechanism behind the inhibition of osteoclast formation is yet unknown. Therefore, we investigated whether mechanical vibration of osteoclast precursor cells affects osteoclast formation by the involvement of fusion-related molecules such as dendritic cell-specific transmembrane protein (DC-STAMP) and P2X7 receptor (P2X7R). RAW264.7 (a murine osteoclastic-like cell line) cells were treated with 20ng/ml receptor activator of NF-κB ligand (RANKL). For 3 consecutive days, the cells were subjected to 1h of mechanical vibration with 20μm displacement at a frequency of 4Hz and compared to the control cells that were treated under the same condition but without the vibration. After 5days of culture, osteoclast formation was determined. Gene expression of DC-STAMP and P2X7R by RAW264.7 cells was determined after 1h of mechanical vibration, while protein production of the DC-STAMP was determined after 6h of postincubation after vibration. As a result, mechanical vibration of RAW264.7 cells inhibited the formation of osteoclasts. Vibration down-regulated DC-STAMP gene expression by 1.6-fold in the presence of RANKL and by 1.4-fold in the absence of RANKL. Additionally, DC-STAMP protein production was also down-regulated by 1.4-fold in the presence of RANKL and by 1.2-fold in the absence of RANKL in RAW264.7 cells in response to mechanical vibration. However, vibration did not affect P2X7R gene expression. Mouse anti-DC-STAMP antibody inhibited osteoclast formation in the absence of vibration. Our results suggest that mechanical vibration of osteoclast precursor cells reduces DC-STAMP expression in osteoclast precursor cells leading to the inhibition of osteoclast formation. © 2013 Elsevier Inc. All rights reserved.

Silicon micro-masonry using elastomeric stamps for three-dimensional microfabrication

International Nuclear Information System (INIS)

Keum, Hohyun; Eisenhaure, Jeffrey D; Kim, Seok; Carlson, Andrew; Ning, Hailong; Mihi, Agustin; Braun, Paul V; Rogers, John A

2012-01-01

We present a micromanufacturing method for constructing microsystems, which we term ‘micro-masonry’ based on individual manipulation, influenced by strategies for deterministic materials assembly using advanced forms of transfer printing. Analogous to masonry in construction sites, micro-masonry consists of the preparation, manipulation, and binding of microscale units to assemble microcomponents and microsystems. In this paper, for the purpose of demonstration, we used microtipped elastomeric stamps as manipulators and built three dimensional silicon microstructures. Silicon units of varied shapes were fabricated in a suspended format on donors, retrieved, delivered, and placed on a target location on a receiver using microtipped stamps. Annealing of the assembled silicon units permanently bound them and completed the micro-masonry procedure. (paper)

Physician Willingness and Resources to Serve More Medicaid..

Data.gov (United States)

U.S. Department of Health & Human Services — Sixteen million people will gain Medicaid under health reform. This study compares primary care physicians (PCPs) on reported acceptance of new Medicaid patients and...

45 CFR 162.1902 - Standard for Medicaid pharmacy subrogation transaction.

Science.gov (United States)

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Standard for Medicaid pharmacy subrogation... DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Medicaid Pharmacy Subrogation § 162.1902 Standard for Medicaid pharmacy subrogation transaction. The Secretary adopts the Batch Standard...

Medicaid program; Medicaid Management Information Systems; performance standards--HCFA. General notice.

Science.gov (United States)

1983-05-31

The purpose of this notice is to respond to the comments we received on the Medicaid Management Information Systems Performance Standards that we published in a notice with comment period on June 30, 1981 (46 FR 33653).

49 CFR 238.119 - Rim-stamped straight-plate wheels.

Science.gov (United States)

2010-10-01

... input to the wheel during braking. (b) A rim-stamped straight-plate wheel shall not be used as a... that is periodically tread-braked for a short duration by automatic circuitry for the sole purpose of...

Factors Related to Medicaid Payment Acceptance at Outpatient Substance Abuse Treatment Programs

Science.gov (United States)

Terry-McElrath, Yvonne M; Chriqui, Jamie F; McBride, Duane C

2011-01-01

Objective To examine factors associated with Medicaid acceptance for substance abuse (SA) services by outpatient SA treatment programs. Data Sources Secondary analysis of 2003–2006 National Survey of Substance Abuse Treatment Services data combined with state Medicaid policy and usage measures and other publicly available data. Study Design We used cross-sectional analyses, including state fixed effects, to assess relationships between SA treatment program Medicaid acceptance and (1) program-level factors, (2) county-level sociodemographics and treatment program density, and (3) state-level population characteristics, SA treatment-related factors, and Medicaid policy and usage. Data Extraction Methods State Medicaid policy data were compiled based on reviews of state Medicaid-related statutes/regulations and Medicaid plans. Other data were publicly available. Principal Findings Medicaid acceptance was significantly higher for programs: (a) that were publicly funded and in states with Medicaid policy allowing SA treatment coverage; (b) with accreditation/licensure and nonprofit/government ownership, as well as mental- and general-health focused programs; and (c) in counties with lower household income. Conclusions SA treatment program Medicaid acceptance related to program-, county, and state-level factors. The data suggest the importance of state policy and licensure/accreditation requirements in increasing SA program Medicaid access. PMID:21105870

Imprints of the Neolithic mind – clay stamps from the Republic of Macedonia

Directory of Open Access Journals (Sweden)

Goce Naumov

2008-12-01

Full Text Available The presence and unusual structure of clay stamps found in Neolithic settlements often give rise to multiple interpretations to define their character. The small dimensions and specific shape of the stamps suggests that these portable objects were important in the social relations and visual communication between members within the same community and, possibly, more distant communities. The definite patterns distinguishe their function in maintaining the visual traditions of the populations inhabiting southeastern Europe. They had an important role in building the Neolithic image modularity, so that they fitted into the comprehensive decorative structure of Neolithic iconography, and the patterns present on the stamps are related to several aspects of Neolithic material culture from the Balkans and Anatolia. This homogeneity of patterns indicates that they were actively included in the transposition of cognition into visual metaphors.

Impact of Medicaid Expansion on Cardiac Surgery Volume and Outcomes.

Science.gov (United States)

Charles, Eric J; Johnston, Lily E; Herbert, Morley A; Mehaffey, J Hunter; Yount, Kenan W; Likosky, Donald S; Theurer, Patricia F; Fonner, Clifford E; Rich, Jeffrey B; Speir, Alan M; Ailawadi, Gorav; Prager, Richard L; Kron, Irving L

2017-10-01

Thirty-one states approved Medicaid expansion after implementation of the Affordable Care Act. The objective of this study was to evaluate the effect of Medicaid expansion on cardiac surgery volume and outcomes comparing one state that expanded to one that did not. Data from the Virginia (nonexpansion state) Cardiac Services Quality Initiative and the Michigan (expanded Medicaid, April 2014) Society of Thoracic and Cardiovascular Surgeons Quality Collaborative were analyzed to identify uninsured and Medicaid patients undergoing coronary bypass graft or valve operations, or both. Demographics, operative details, predicted risk scores, and morbidity and mortality rates, stratified by state and compared across era (preexpansion: 18 months before vs postexpansion: 18 months after), were analyzed. In Virginia, there were no differences in volume between eras, whereas in Michigan, there was a significant increase in Medicaid volume (54.4% [558 of 1,026] vs 84.1% [954 of 1,135], p Medicaid patients, there were no differences in predicted risk of morbidity or mortality or postoperative major morbidities. In Michigan Medicaid patients, a significant decrease in predicted risk of morbidity or mortality (11.9% [8.1% to 20.0%] vs 11.1% [7.7% to 17.9%], p = 0.02) and morbidities (18.3% [102 of 558] vs 13.2% [126 of 954], p = 0.008) was identified. Postexpansion was associated with a decreased risk-adjusted rate of major morbidity (odds ratio, 0.69; 95% confidence interval, 0.51 to 0.91; p = 0.01) in Michigan Medicaid patients. Medicaid expansion was associated with fewer uninsured cardiac surgery patients and improved predicted risk scores and morbidity rates. In addition to improving health care financing, Medicaid expansion may positively affect patient care and outcomes. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

76 FR 60050 - Medicaid Program: Money Follows the Person Rebalancing Demonstration Program

Science.gov (United States)

2011-09-28

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Medicaid Program: Money Follows the Person Rebalancing Demonstration Program AGENCY: Centers for Medicare & Medicaid... Medicaid beneficiaries with disabling and chronic conditions from institutions into the community. The...

Improving access for Medicaid-insured children: focus on front-office personnel.

Science.gov (United States)

Lam, M; Riedy, C A; Milgrom, P

1999-03-01

Access to dental services for low-income children is limited. Front-office personnel play a role regarding dentists' participation in the Medicaid program. Subjects (N = 24) represented general dental offices in Spokane County, Wash., and included participants and nonparticipants in the Access to Baby and Child Dentistry, or ABCD, program, a dental society/community program aimed at expanding dental services provided to Medicaid-insured children. The authors stratified the participants according to the number of claims their practices submitted to Medicaid for ABCD children: non-ABCD, low-ABCD and high-ABCD. Five two-hour focus group sessions were conducted to determine participants' beliefs about, attitudes toward and experiences in serving this population. The authors' data analysis consisted of a comprehensive content review of participants' responses from transcripted audiotapes. They synthesized frequently mentioned concepts and ideas into relevant themes. The major factors affecting practices' participation in Medicaid were office policy on seeing Medicaid-insured patients; staff members' personal connection to Medicaid-insured patients; staff members' attitudes about Medicaid-insured patients; and staff members' perceptions of Medicaid-insured patients' barriers to care. The data suggest that factors affecting dentists' participation in the Medicaid program are more complex than the often-stated dissatisfactions with low reimbursement fees and hassles with paperwork. Efforts to increase dentist participation in serving Medicaid-insured patients will continue to be relatively ineffective until many of the concerns raised by this study's subjects are better understood and addressed.

Influence of Plastic Deformation on Martensitic Transformation During Hot Stamping of Complex Structure Auto Parts

Science.gov (United States)

Shen, Yuhan; Song, Yanli; Hua, Lin; Lu, Jue

2017-04-01

The ultra-high strength steel auto parts manufactured by hot stamping are widely applied for weight reduction and safety improvement. During the hot stamping process, hot forming and quenching are performed in one step wherein plastic deformation and phase transformation simultaneously take place and affect each other. Thereinto, the influence of deformation on martensitic transformation is of great importance. In the present paper, the influence of plastic deformation on martensitic transformation during hot stamping of complex structure auto parts was investigated. For this purpose, a B-pillar reinforced panel in B1500HS steel was manufactured by hot stamping, and the process was simulated by finite element software based on a thermo-mechanical-metallurgical coupled model. Considering various deformation degrees, the microstructures and mechanical properties at four typical locations of the hot stamped B-pillar reinforced panel were detected. The results show that the martensitic content and the microhardness increase with the increase in the deformation amount. There are two reasons causing this phenomenon: (1) the increase in mechanical driving force and (2) the increased probability of the martensitic nucleation at crystal defects. The x-ray diffraction analysis indicates the carbon enrichment in retained austenite which results from the carbon diffusion during the low-carbon martensite formation. Furthermore, the carbon content decreases with the increase in the deformation amount, because the deformation of austenite suppresses the carbon diffusion.

75 FR 38748 - Medicaid Program; Premiums and Cost Sharing; Correction

Science.gov (United States)

2010-07-06

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 447 and 457 [CMS-2244-CN] RIN 0938-AP73 Medicaid Program; Premiums and Cost Sharing; Correction AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS ACTION: Correction of final rule with comment period...

How Medicaid agencies administer mental health services: results from a 50-state survey.

Science.gov (United States)

Verdier, James; Barrett, Allison

2008-10-01

This brief report describes some notable variations in how state Medicaid agencies administer and fund Medicaid mental health services. Hour-long telephone interviews were conducted with all state and District of Columbia Medicaid directors or their designees. Responses indicated that Medicaid and mental health agencies were located within the same umbrella agency in 28 states, potentially facilitating collaboration. The mental health agency provided funding for some Medicaid mental health services in 32 states, and counties provided such funding in 22 states. Medicaid agencies generally delegated more authority to state mental health agencies in states where some Medicaid funding came from mental health sources and also in states where both agencies were in the same umbrella agency. The increasing role of Medicaid in funding state mental health services, combined with new federal limits on Medicaid financing of these services, underscores the importance of interagency collaboration and better alignment of Medicaid and mental health responsibilities.

Food Stamps and Food Insecurity: What Can Be Learned in the Presence of Nonclassical Measurement Error?

Science.gov (United States)

Gundersen, Craig; Kreider, Brent

2008-01-01

Policymakers have been puzzled to observe that food stamp households appear more likely to be food insecure than observationally similar eligible nonparticipating households. We reexamine this issue allowing for nonclassical reporting errors in food stamp participation and food insecurity. Extending the literature on partially identified…

45 CFR 205.25 - Eligibility of supplemental security income beneficiaries for food stamps or surplus commodities.

Science.gov (United States)

2010-10-01

... beneficiaries for food stamps or surplus commodities. 205.25 Section 205.25 Public Welfare Regulations Relating....25 Eligibility of supplemental security income beneficiaries for food stamps or surplus commodities... XVI of the Social Security Act, the State agency shall make the following determinations: (1) The...

The collection of Tuvan stamps (1926–1943 in the National Museum of the Republic of Tuva and the prospects of philately in Tuva

Directory of Open Access Journals (Sweden)

Kaadyr-ool A. Bicheldey

2016-09-01

Full Text Available Stamps of the People’s Republic of Tuva (PRT, 1921-1944 as indicia and as items of collectors’ interest, are universally renowned, and as such have been the subject of a good deal of research. These works contain more than a mere story of Tuvan stamps – they provide a lot of useful information on Tuva, its history, including the history of postal service in the region. This article describes the collection of indicia (more than 500 pieces dated 1926-1943 and preserved at Aldan Maadyr National Museum of Tuva. On the basis of this analysis we have formulated the current problems and prospects of philately in the region. The stamp collection in the National Museum fills 4 albums of various sizes and a number of envelopes with 1-72 stamps in each. The compilers of 2 albums attempted to systematize stamps by issue date, but this work is far from complete. There is no definitive collection of Tuvan stamps to act as a model for others, regardless of the quality of the stamps preserved. The rest of the stamps in the museum collection is in unsorted state. Overall, the degree of preservation can be tentatively described as average. Given the great interest of scholars and collectors, Tuvan stamps are relatively little studies. The overall bulk of material on the uses of stamps in Tuva lacks an overarching study. We have summed up the main research problems that call for in-depth research, including studying Tuvan stamps as pieces of art, the financial and economic viability of issuing stamps in PRT, the official documentations licensing the issue, full catalogization of all existing issues, the study of individual stamps, etc. Especially urgent is the issue of propagating knowledge of history of Tuvan postal service as a precondition for collecting and preserving PRT stamps. Archives of many Tuvan families may contain unique stamps, rare envelopes or postcards – but few of their owners recognize the full value of what they have. This puts unique

75 FR 46833 - 45th Anniversary of Medicare and Medicaid

Science.gov (United States)

2010-08-03

... Part III The President Proclamation 8544--45th Anniversary of Medicare and Medicaid #0; #0; #0..., 2010 45th Anniversary of Medicare and Medicaid By the President of the United States of America A Proclamation When President Lyndon B. Johnson signed Medicare and Medicaid into law on July 30, 1965, millions...

42 CFR 441.206 - Documentation needed by the Medicaid agency.

Science.gov (United States)

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Documentation needed by the Medicaid agency. 441.206 Section 441.206 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND... SPECIFIC SERVICES Abortions § 441.206 Documentation needed by the Medicaid agency. FFP is not available in...

Transfer Taxes and Household Mobility: Distortion on the Housing or Labor Market?

OpenAIRE

Christian A. L. Hilber; Teemu Lyytikäinen

2015-01-01

We estimate the effect of the UK Stamp Duty Land Tax (SDLT) - a transfer tax on the purchase price of property or land - on different types of household mobility using micro data. Exploiting a discontinuity in the tax schedule, we isolate the impact of the tax from other determinants of mobility. We compare homeowners with self-assessed house values on either sides of a cut-off value where the tax rate jumps from 1 to 3 percent. We find that a higher SDLT has a strong negative impact on housi...

Impact of Electronic Signatures and Time Stamping for the Protection of Electronic Agreements

Directory of Open Access Journals (Sweden)

Tadas Limba

2012-12-01

Full Text Available The article e495 valuates the impact of e-signatures and time stamping on electronic contracts and electronic documents for performing e-business opportunities and goals, and analyses e-signature application for business cases. Various electronic services, virtual shopping, electronic cash transactions are becoming increasingly popular as they allow users to quickly perform different actions, operations and functions. It is important not only for convenience, but also to ensure consumer data security and reliability. Security reasons are not enough for security transmitted data, since this method does not allow clarification of information about sender identity.Use of electronic signatures, electronic identities, checgs and ensures a very high level of data security in interchange data processes. E-signature allows e-business companies to transfer the company’s operation business processes and their application to the organization and management in the electronic environment, also automate internal and external compans processes, includinggon-going business processes.The object of paper is .-signature and time stamping application in the theoretical and practical way.The goal of this paper while evaluating and estimating the .-signature and time stamping application, i’s regulation and legal implementation worldwidesand in Lithuania—is to provideluseful recommendations for more efficient impact developing -commerce and -business in situations when -signature and time stamping is used for ensuring electronic contracs security.

Impact of Electronic Signatures and Time Stamping for the Protection of Electronic Agreements

Directory of Open Access Journals (Sweden)

Tadas Limba

2013-02-01

Full Text Available The article e495 valuates the impact of e-signatures and time stamping on electronic contracts and electronic documents for performing e-business opportunities and goals, and analyses e-signature application for business cases. Various electronic services, virtual shopping, electronic cash transactions are becoming increasingly popular as they allow users to quickly perform different actions, operations and functions. It is important not only for convenience, but also to ensure consumer data security and reliability. Security reasons are not enough for security transmitted data, since this method does not allow clarification of information about sender identity. Use of electronic signatures, electronic identities, checgs and ensures a very high level of data security in interchange data processes. E-signature allows e-business companies to transfer the company’s operation business processes and their application to the organization and management in the electronic environment, also automate internal and external compans processes, includinggon-going business processes. The object of paper is .-signature and time stamping application in the theoretical and practical way. The goal of this paper while evaluating and estimating the .-signature and time stamping application, i’s regulation and legal implementation worldwidesand in Lithuania—is to provideluseful recommendations for more efficient impact developing -commerce and -business in situations when -signature and time stamping is used for ensuring electronic contracs security.

42 CFR 460.90 - PACE benefits under Medicare and Medicaid.

Science.gov (United States)

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false PACE benefits under Medicare and Medicaid. 460.90 Section 460.90 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... FOR THE ELDERLY (PACE) PACE Services § 460.90 PACE benefits under Medicare and Medicaid. If a Medicare...

20 CFR 416.266 - Continuation of SSI status for Medicaid

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Continuation of SSI status for Medicaid 416... Disabling Impairment § 416.266 Continuation of SSI status for Medicaid If we stop your benefits because of... to be considered an SSI recipient for purposes of eligibility for Medicaid during the time it takes...

42 CFR 433.40 - Treatment of uncashed or cancelled (voided) Medicaid checks.

Science.gov (United States)

2010-10-01

...) Medicaid checks. 433.40 Section 433.40 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT...) Medicaid checks. (a) Purpose. This section provides the rules to ensure that States refund the Federal...— Cancelled (voided) check means a Medicaid check issued by a State or fiscal agent which prior to its being...

42 CFR 1007.9 - Relationship to, and agreement with, the Medicaid agency.

Science.gov (United States)

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Relationship to, and agreement with, the Medicaid... AND HUMAN SERVICES OIG AUTHORITIES STATE MEDICAID FRAUD CONTROL UNITS § 1007.9 Relationship to, and agreement with, the Medicaid agency. (a) The unit must be separate and distinct from the Medicaid agency. (b...

Medicaid Waivers and Public Sector Mental Health Service Penetration Rates for Youth.

Science.gov (United States)

Graaf, Genevieve; Snowden, Lonnie

2018-01-22

To assist families of youth with serious emotional disturbance in financing youth's comprehensive care, some states have sought and received Medicaid waivers. Medicaid waivers waive or relax the Medicaid means test for eligibility to provide insurance coverage to nonpoor families for expensive, otherwise out-of-reach treatment for youth with Serious Emotional Disturbance (SED). Waivers promote treatment access for the most troubled youth, and the present study investigated whether any of several Medicaid waiver options-and those that completely omit the means test in particular-are associated with higher state-wide public sector treatment penetration rates. The investigators obtained data from the U.S. Census, SAMHSA's Uniform Reporting System, and the Centers for Medicare and Medicaid Services. Analysis employed random intercept and random slope linear regression models, controlling for a variety of state demographic and fiscal variables, to determine whether a relationship between Medicaid waiver policies and state-level public sector penetration rates could be observed. Findings indicate that, whether relaxing or completely waiving Medicaid's qualifying income limits, waivers increase public sector penetration rates, particularly for youth under age 17. However, completely waiving Medicaid income limits did not uniquely contribute to penetration rate increases. States offering Medicaid waivers that either relax or completely waive Medicaid's means test to qualify for health coverage present higher public sector treatment rates for youth with behavioral health care needs. There is no evidence that restricting the program to waiving the means test for accessing Medicaid would increase treatment access. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

State Variation in Medicaid Reimbursements for Orthopaedic Surgery.

Science.gov (United States)

Lalezari, Ramin M; Pozen, Alexis; Dy, Christopher J

2018-02-07

Medicaid reimbursements are determined by each state and are subject to variability. We sought to quantify this variation for commonly performed inpatient orthopaedic procedures. The 10 most commonly performed inpatient orthopaedic procedures, as ranked by the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample, were identified for study. Medicaid reimbursement amounts for those procedures were benchmarked to state Medicare reimbursement amounts in 3 ways: (1) ratio, (2) dollar difference, and (3) dollar difference divided by the relative value unit (RVU) amount. Variability was quantified by determining the range and coefficient of variation for those reimbursement amounts. The range of variability of Medicaid reimbursements among states exceeded $1,500 for all 10 procedures. The coefficients of variation ranged from 0.32 (hip hemiarthroplasty) to 0.57 (posterior or posterolateral lumbar interbody arthrodesis) (a higher coefficient indicates greater variability), compared with 0.07 for Medicare reimbursements for all 10 procedures. Adjusted as a dollar difference between Medicaid and Medicare per RVU, the median values ranged from -$8/RVU (total knee arthroplasty) to -$17/RVU (open reduction and internal fixation of the femur). Variability of Medicaid reimbursement for inpatient orthopaedic procedures among states is substantial. This variation becomes especially remarkable given recent policy shifts toward focusing reimbursements on value.

Solid-state superionic stamping with silver iodide-silver metaphosphate glass

International Nuclear Information System (INIS)

Jacobs, K E; Hsu, K H; Han, X; Azeredo, B P; Ferreira, P M; Kumar, A; Fang, N X

2011-01-01

This paper demonstrates and analyzes the new use of the glassy solid electrolyte AgI-AgPO 3 for direct nanopatterning of thin silver films with feature resolutions of 30 nm. AgI-AgPO 3 has a high room temperature ionic conductivity with Ag + as the mobile ion, leading to silver etch/patterning rates of up to 20 nm s -1 at an applied bias of 300 mV. The glass can be melt-processed at temperatures below 200 deg. C, providing a facile and economical pathway for creating large area stamps, including the 25 mm 2 stamps shown in this study. Further, the glass is sufficiently transparent to permit integration with existing tools such as aligners and imprint tools, enabling high overlay registration accuracy and facilitating insertion into multi-step fabrication recipes.

Social Work's Role in Medicaid Reform: A Qualitative Study.

Science.gov (United States)

Bachman, Sara S; Wachman, Madeline; Manning, Leticia; Cohen, Alexander M; Seifert, Robert W; Jones, David K; Fitzgerald, Therese; Nuzum, Rachel; Riley, Patricia

2017-12-01

To critically analyze social work's role in Medicaid reform. We conducted semistructured interviews with 46 stakeholders from 10 US states that use a range of Medicaid reform approaches. We identified participants using snowball and purposive sampling. We gathered data in 2016 and analyzed them using qualitative methods. Multiple themes emerged: (1) social work participates in Medicaid reform through clinical practice, including care coordination and case management; (2) there is a gap between social work's practice-level and systems-level involvement in Medicaid innovations; (3) factors hindering social work's involvement in systems-level practice include lack of visibility, insufficient clarity on social work's role and impact, and too few resources within professional organizations; and (4) social workers need more training in health transformation payment models and policy. Social workers have unique skills that are valuable to building health systems that promote population health and reduce health inequities. Although there is considerable opportunity for social work to increase its role in Medicaid reform, there is little social work involvement at the systems level.

Medicaid and Rural Health

Science.gov (United States)

... State Guides Rural Data Visualizations Rural Data Explorer Chart Gallery Maps Case Studies & Conversations Rural Health Models & ... services provided by state Medicaid programs might include dental care, physical therapy, home and community-based services, ...

Medicaid CHIP ESPC Database

Data.gov (United States)

U.S. Department of Health & Human Services — The Environmental Scanning and Program Characteristic (ESPC) Database is in a Microsoft (MS) Access format and contains Medicaid and CHIP data, for the 50 states and...

Failure Mechanisms of the Protective Coatings for the Hot Stamping Applications

Science.gov (United States)

Zhao, Chen

In the present study, four different nitriding techniques were carried on the ductile irons NAAMS-D6510 and cast steels NAAMS-S0050A, which are widely used stamping die materials; duplex treatments (PVD CrN coating+nitriding) were carried on H13 steels, which are common inserts for the hot stamping dies. Inclined impact-sliding wear tests were performed on the nitriding cases under simulated stamping conditions. Surface profilometer, scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS) and X-ray photoelectron spectroscopy (XPS) were used to investigate the wear and failure mechanisms of the protective coatings. It was found that the nitrided ductile iron samples performed better than the nitrided cast steel specimens. High temperature inclined impact-sliding wear tests were carried out on the CrN coatings. It was found that the coating performed better at elevated temperature. XPS analysis indicated the top surface layer (about 3-4nm) of the coating was oxidized at 400 °C and formed a Cr2O3 protective film. The in-situ formation of the thin Cr2O3 protective layer likely led to the change of wear mechanisms from severe adhesive failure to mild abrasive wear.

Martensitic microstructural transformations from the hot stamping, quenching and partitioning process

International Nuclear Information System (INIS)

Liu Heping; Jin Xuejun; Dong Han; Shi Jie

2011-01-01

Hot stamping, which combines forming and quenching in one process, produces high strength steels with limited ductility because the quenching is uncontrolled. A new processing technique has been proposed in which the hot stamping step is followed by a controlled quenching and partitioning process, producing a microstructure containing retained austenite and martensite. To investigate this microstructure, specimens were heated at a rate of 10 deg. C/s to the austenitizing temperature of 900 deg. C, held for 5 min to eliminate thermal gradients, and cooled at a rate of 50 deg. C/s to a quenching temperature of 300 deg. C, which is between the martensite start temperature and the martensite finish temperatures. The resulting microstructure was examined using optical microscope, scanning electron microscopy and transmission electron microscopy. The material produced contains irregular, fragmented martensite plates, a result of the improved strength of the austenite phase and the constraints imposed by a high dislocation density. - Research Highlights: → A novel heat treatment of advanced high strength steels is proposed. → The processing technique is hot stamping plus quenching and partitioning process. → The material produced contains irregular, fragmented martensite plates. → The reason is strength of austenite phase and constraint of dislocation density.

Probabilistic Design in a Sheet Metal Stamping Process under Failure Analysis

International Nuclear Information System (INIS)

Buranathiti, Thaweepat; Cao, Jian; Chen, Wei; Xia, Z. Cedric

2005-01-01

Sheet metal stamping processes have been widely implemented in many industries due to its repeatability and productivity. In general, the simulations for a sheet metal forming process involve nonlinearity, complex material behavior and tool-material interaction. Instabilities in terms of tearing and wrinkling are major concerns in many sheet metal stamping processes. In this work, a sheet metal stamping process of a mild steel for a wheelhouse used in automobile industry is studied by using an explicit nonlinear finite element code and incorporating failure analysis (tearing and wrinkling) and design under uncertainty. Margins of tearing and wrinkling are quantitatively defined via stress-based criteria for system-level design. The forming process utilizes drawbeads instead of using the blank holder force to restrain the blank. The main parameters of interest in this work are friction conditions, drawbead configurations, sheet metal properties, and numerical errors. A robust design model is created to conduct a probabilistic design, which is made possible for this complex engineering process via an efficient uncertainty propagation technique. The method called the weighted three-point-based method estimates the statistical characteristics (mean and variance) of the responses of interest (margins of failures), and provide a systematic approach in designing a sheet metal forming process under the framework of design under uncertainty

Medicaid provider reimbursement policy for adult immunizations.

Science.gov (United States)

Stewart, Alexandra M; Lindley, Megan C; Cox, Marisa A

2015-10-26

State Medicaid programs establish provider reimbursement policy for adult immunizations based on: costs, private insurance payments, and percentage of Medicare payments for equivalent services. Each program determines provider eligibility, payment amount, and permissible settings for administration. Total reimbursement consists of different combinations of Current Procedural Terminology codes: vaccine, vaccine administration, and visit. Determine how Medicaid programs in the 50 states and the District of Columbia approach provider reimbursement for adult immunizations. Observational analysis using document review and a survey. Medicaid administrators in 50 states and the District of Columbia. Whether fee-for-service programs reimburse providers for: vaccines; their administration; and/or office visits when provided to adult enrollees. We assessed whether adult vaccination services are reimbursed when administered by a wide range of providers in a wide range of settings. Medicaid programs use one of 4 payment methods for adults: (1) a vaccine and an administration code; (2) a vaccine and visit code; (3) a vaccine code; and (4) a vaccine, visit, and administration code. Study results do not reflect any changes related to implementation of national health reform. Nine of fifty one programs did not respond to the survey or declined to participate, limiting the information available to researchers. Medicaid reimbursement policy for adult vaccines impacts provider participation and enrollee access and uptake. While programs have generally increased reimbursement levels since 2003, each program could assess whether current policies reflect the most effective approach to encourage providers to increase vaccination services. Copyright © 2015 Elsevier Ltd. All rights reserved.

Medicaid provider reimbursement policy for adult immunizations☆

Science.gov (United States)

Stewart, Alexandra M.; Lindley, Megan C.; Cox, Marisa A.

2015-01-01

Background State Medicaid programs establish provider reimbursement policy for adult immunizations based on: costs, private insurance payments, and percentage of Medicare payments for equivalent services. Each program determines provider eligibility, payment amount, and permissible settings for administration. Total reimbursement consists of different combinations of Current Procedural Terminology codes: vaccine, vaccine administration, and visit. Objective Determine how Medicaid programs in the 50 states and the District of Columbia approach provider reimbursement for adult immunizations. Design Observational analysis using document review and a survey. Setting and participants Medicaid administrators in 50 states and the District of Columbia. Measurements Whether fee-for-service programs reimburse providers for: vaccines; their administration; and/or office visits when provided to adult enrollees. We assessed whether adult vaccination services are reimbursed when administered by a wide range of providers in a wide range of settings. Results Medicaid programs use one of 4 payment methods for adults: (1) a vaccine and an administration code; (2) a vaccine and visit code; (3) a vaccine code; and (4) a vaccine, visit, and administration code. Limitations Study results do not reflect any changes related to implementation of national health reform. Nine of fifty one programs did not respond to the survey or declined to participate, limiting the information available to researchers. Conclusions Medicaid reimbursement policy for adult vaccines impacts provider participation and enrollee access and uptake. While programs have generally increased reimbursement levels since 2003, each program could assess whether current policies reflect the most effective approach to encourage providers to increase vaccination services. PMID:26403369

Medicaid/CHIP Program; Medicaid Program and Children's Health Insurance Program (CHIP); Changes to the Medicaid Eligibility Quality Control and Payment Error Rate Measurement Programs in Response to the Affordable Care Act. Final rule.

Science.gov (United States)

2017-07-05

This final rule updates the Medicaid Eligibility Quality Control (MEQC) and Payment Error Rate Measurement (PERM) programs based on the changes to Medicaid and the Children's Health Insurance Program (CHIP) eligibility under the Patient Protection and Affordable Care Act. This rule also implements various other improvements to the PERM program.

78 FR 28551 - Medicaid Program; State Disproportionate Share Hospital Allotment Reductions

Science.gov (United States)

2013-05-15

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Part 447 [CMS-2367-P] RIN 0938-AR31 Medicaid Program; State Disproportionate Share Hospital Allotment Reductions AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Proposed rule. SUMMARY: The statute...

78 FR 57293 - Medicaid Program; State Disproportionate Share Hospital Allotment Reductions

Science.gov (United States)

2013-09-18

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Part 447 [CMS-2367-F] RIN 0938-AR31 Medicaid Program; State Disproportionate Share Hospital Allotment Reductions AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Final rule. SUMMARY: The statute, as...

Impact of state Medicaid coverage on utilization of inpatient rehabilitation facilities among patients with stroke.

Science.gov (United States)

Skolarus, Lesli E; Burke, James F; Morgenstern, Lewis B; Meurer, William J; Adelman, Eric E; Kerber, Kevin A; Callaghan, Brian C; Lisabeth, Lynda D

2014-08-01

Poststroke rehabilitation is associated with improved outcomes. Medicaid coverage of inpatient rehabilitation facility (IRF) admissions varies by state. We explored the role of state Medicaid IRF coverage on IRF utilization among patients with stroke. Working age ischemic stroke patients with Medicaid were identified from the 2010 Nationwide Inpatient Sample. Medicaid coverage of IRFs (yes versus no) was ascertained. Primary outcome was discharge to IRF (versus other discharge destinations). We fit a logistic regression model that included patient demographics, Medicaid coverage, comorbidities, length of stay, tissue-type plasminogen activator use, state Medicaid IRF coverage, and the interaction between patient Medicaid status and state Medicaid IRF coverage while accounting for hospital clustering. Medicaid did not cover IRFs in 4 (TN, TX, SC, WV) of 42 states. The impact of State Medicaid IRF coverage was limited to Medicaid stroke patients (P for interaction stroke patients in states with Medicaid IRF coverage, Medicaid stroke patients hospitalized in states without Medicaid IRF coverage were less likely to be discharged to an IRF of 11.6% (95% confidence interval, 8.5%-14.7%) versus 19.5% (95% confidence interval, 18.3%-20.8%), Pstroke patients with Medicaid. Given the increasing stroke incidence among the working age and Medicaid expansion under the Affordable Care Act, careful attention to state Medicaid policy for poststroke rehabilitation and analysis of its effects on stroke outcome disparities are warranted. © 2014 American Heart Association, Inc.

The Effects of Medicaid Policy Changes on Adults Service...

Data.gov (United States)

U.S. Department of Health & Human Services — The Effects of Medicaid Policy Changes on Adults Service Use Patterns in Kentucky and Idaho According to findings reported in The Effects of Medicaid Policy Changes...

The Impact of Medicaid Peer Support Utilization on Cost

Data.gov (United States)

U.S. Department of Health & Human Services — According to findings reported in The Impact of Medicaid Peer Support Utilization on Cost, published in Volume 4, Issue 1 of the Medicare and Medicaid Research...

Evaluation of Contact Heat Transfer Coefficient and Phase Transformation during Hot Stamping of a Hat-Type Part

Science.gov (United States)

Kim, Heung-Kyu; Lee, Seong Hyeon; Choi, Hyunjoo

2015-01-01

Using an inverse analysis technique, the heat transfer coefficient on the die-workpiece contact surface of a hot stamping process was evaluated as a power law function of contact pressure. This evaluation was to determine whether the heat transfer coefficient on the contact surface could be used for finite element analysis of the entire hot stamping process. By comparing results of the finite element analysis and experimental measurements of the phase transformation, an evaluation was performed to determine whether the obtained heat transfer coefficient function could provide reasonable finite element prediction for workpiece properties affected by the hot stamping process. PMID:28788046

Medicaid Reimbursement of Mental Health Peer-Run Organizations: Results of a National Survey.

Science.gov (United States)

Ostrow, Laysha; Steinwachs, Donald; Leaf, Philip J; Naeger, Sarah

2017-07-01

This study sought to understand whether knowledge of the Affordable Care Act (ACA) was associated with willingness of mental health peer-run organizations to become Medicaid providers. Through the 2012 National Survey of Peer-Run Organizations, organizational directors reported their organization's willingness to accept Medicaid reimbursement and knowledge about the ACA. Multinomial logistic regression was used to model the association between willingness to accept Medicaid and the primary predictor of knowledge of the ACA, as well as other predictors at the organizational and state levels. Knowledge of the ACA, Medicaid expansion, and discussions about healthcare reform were not significantly associated with willingness to be a Medicaid provider. Having fewer paid staff was associated with not being willing to be a Medicaid provider, suggesting that current staffing capacity is related to attitudes about becoming a Medicaid provider. Organizations had both ideological and practical concerns about Medicaid reimbursement. Concerns about Medicaid reimbursement can potentially be addressed through alternative financing mechanisms that should be able to meet the needs of peer-run organizations.

42 CFR 460.168 - Reinstatement in other Medicare and Medicaid programs.

Science.gov (United States)

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Reinstatement in other Medicare and Medicaid programs. 460.168 Section 460.168 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... Reinstatement in other Medicare and Medicaid programs. To facilitate a participant's reinstatement in other...

42 CFR 457.350 - Eligibility screening and facilitation of Medicaid enrollment.

Science.gov (United States)

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Eligibility screening and facilitation of Medicaid enrollment. 457.350 Section 457.350 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... Eligibility screening and facilitation of Medicaid enrollment. (a) State plan requirement. The State plan must...

42 CFR 1002.3 - Disclosure by providers and State Medicaid agencies.

Science.gov (United States)

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Disclosure by providers and State Medicaid agencies... HUMAN SERVICES OIG AUTHORITIES PROGRAM INTEGRITY-STATE-INITIATED EXCLUSIONS FROM MEDICAID General Provisions § 1002.3 Disclosure by providers and State Medicaid agencies. (a) Information that must be...

Do Medicaid home and community based service waivers save money?

Science.gov (United States)

Harrington, Charlene; Ng, Terence; Kitchener, Martin

2011-10-01

This article estimates the potential savings to the Medicaid program of using 1915c Home and Community Based Services (HCBS) waivers rather than institutional care. For Medicaid HCBS waiver expenditures of $25 billion in 2006, we estimate the national savings to be over $57 billion, or $57,338 per waiver participant in 2006 compared with the cost of Medicaid institutional care (for which all waiver participants are eligible). When taking into account a potential 50% "woodwork effect" (for people who might have refused institutional services), the saving would be $21 billion. This analysis demonstrates that HCBS waiver programs present significant direct financial savings to Medicaid long-term care (LTC) programs.

Development and introduction of stamping technique for large-size laterals of NPP pipelines

International Nuclear Information System (INIS)

Romashko, N.I.; Moshnin, E.N.; Timokhin, V.S.; Bryukhanov, Yu.V.; Lebedev, V.A.

1984-01-01

The results of development and introduction of stamping technique for large-size laterals of NPP high-pressure pipelines are presented. The main experimental data characterizing technological possibilities of the process are given. The technological process and design of the stamp assure production of laterals from ovalized bars per one heating of the bar and per one running of the press cronnhead. Introduction of new technology decreased labour input of lateral production, reliability and serviceability of pipelines increased in this case. Introduction of this technology gives a considerable benefit

7 CFR 275.4 - Record retention.

Science.gov (United States)

2010-01-01

... materials supporting the review decision; sample lists; sampling frames; tabulation sheets; and reports of... Stamps and Medicaid Quality Control Reviews, FNS-380-1, Integrated Review Schedule, FNS-245, Negative...

77 FR 17143 - Medicaid Program; Eligiblity Changes Under the Affordable Care Act of 2010

Science.gov (United States)

2012-03-23

... Medicare and Medicaid Services 42 CFR Parts 431, 435 and 457 Medicaid Program; Eligibility Changes Under... for Medicare & Medicaid Services 42 CFR Parts 431, 435, and 457 [CMS-2349-F] RIN 0938-AQ62 Medicaid Program; Eligiblity Changes Under the Affordable Care Act of 2010 AGENCY: Centers for Medicare & Medicaid...

42 CFR 456.171 - Medicaid agency review of need for admission.

Science.gov (United States)

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Medicaid agency review of need for admission. 456.171 Section 456.171 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND... Hospitals Medical, Psychiatric, and Social Evaluations and Admission Review § 456.171 Medicaid agency review...

State variation in primary care physician supply: implications for health reform Medicaid expansions.

Science.gov (United States)

Cunningham, Peter J

2011-03-01

Under the Patient Protection and Affordable Care Act (PPACA), Medicaid enrollment is expected to grow by 16 million people by 2019, an increase of more than 25 percent. Given the unwillingness of many primary care physicians (PCPs) to treat new Medicaid patients, policy makers and others are concerned about adequate primary care capacity to meet the increased demand. States with the smallest number of PCPs per capita overall--gen­erally in the South and Mountain West--potentially will see the largest per­centage increases in Medicaid enrollment, according to a new national study by the Center for Studying Health System Change (HSC). In contrast, states with the largest number of PCPs per capita--primarily in the Northeast--will see more modest increases in Medicaid enrollment. Moreover, geograph­ic differences in PCP acceptance of new Medicaid patients reflect differences in overall PCP supply, not geographic differences in PCPs' willingness to treat Medicaid patients. The law also increases Medicaid reimbursement rates for certain services provided by primary care physicians to 100 percent of Medicare rates in 2013 and 2014. However, the reimbursement increases are likely to have the greatest impact in states that already have a large number of PCPs accepting Medicaid patients. In fact, the percent increase of PCPs accepting Medicaid patients in these states is likely to exceed the percent increase of new Medicaid enrollees. The reimbursement increases will have much less impact in states with a relatively small number of PCPs accepting Medicaid patients now because many of these states already reimburse primary care at rates close to or exceeding 100 percent of Medicare. As a result, growth in Medicaid enrollment in these states will greatly outpace growth in the num­ber of primary care physicians willing to treat new Medicaid patients.

A framework for development of an intelligent system for design and manufacturing of stamping dies

International Nuclear Information System (INIS)

Hussein, H M A; Kumar, S

2014-01-01

An integration of computer aided design (CAD), computer aided process planning (CAPP) and computer aided manufacturing (CAM) is required for development of an intelligent system to design and manufacture stamping dies in sheet metal industries. In this paper, a framework for development of an intelligent system for design and manufacturing of stamping dies is proposed. In the proposed framework, the intelligent system is structured in form of various expert system modules for different activities of design and manufacturing of dies. All system modules are integrated with each other. The proposed system takes its input in form of a CAD file of sheet metal part, and then system modules automate all tasks related to design and manufacturing of stamping dies. Modules are coded using Visual Basic (VB) and developed on the platform of AutoCAD software

A framework for development of an intelligent system for design and manufacturing of stamping dies

Science.gov (United States)

Hussein, H. M. A.; Kumar, S.

2014-07-01

An integration of computer aided design (CAD), computer aided process planning (CAPP) and computer aided manufacturing (CAM) is required for development of an intelligent system to design and manufacture stamping dies in sheet metal industries. In this paper, a framework for development of an intelligent system for design and manufacturing of stamping dies is proposed. In the proposed framework, the intelligent system is structured in form of various expert system modules for different activities of design and manufacturing of dies. All system modules are integrated with each other. The proposed system takes its input in form of a CAD file of sheet metal part, and then system modules automate all tasks related to design and manufacturing of stamping dies. Modules are coded using Visual Basic (VB) and developed on the platform of AutoCAD software.

Numerical simulation of temperature field, microstructure evolution and mechanical properties of HSS during hot stamping

International Nuclear Information System (INIS)

Shi, Dongyong; Liu, Wenquan; Ying, Liang; Hu, Ping; Shen, Guozhe

2013-01-01

The hot stamping of boron steels is widely used to produce ultra high strength automobile components without any spring back. The ultra high strength of final products is attributed to the fully martensitic microstructure that is obtained through the simultaneous forming and quenching of the hot blanks after austenization. In the present study, a mathematical model incorporating both heat transfer and the transformation of austenite is presented. A FORTRAN program based on finite element technique has been developed which permits the temperature distribution and microstructure evolution of high strength steel during hot stamping process. Two empirical diffusion-dependent transformation models under isothermal conditions were employed respectively, and the prediction capability on mechanical properties of the models were compared with the hot stamping experiment of an automobile B-pillar part

High-Expenditure Pharmaceutical Use Among Children in Medicaid.

Science.gov (United States)

Cohen, Eyal; Hall, Matt; Lopert, Ruth; Bruen, Brian; Chamberlain, Lisa J; Bardach, Naomi; Gedney, Jennifer; Zima, Bonnie T; Berry, Jay G

2017-09-01

Medication use may be a target for quality improvement, cost containment, and research. We aimed to identify medication classes associated with the highest expenditures among pediatric Medicaid enrollees and to characterize the demographic, clinical, and health service use of children prescribed these medications. Retrospective, cross-sectional study of 3 271 081 Medicaid-enrolled children. Outpatient medication spending among high-expenditure medication classes, defined as the 10 most expensive among 261 mutually exclusive medication classes, was determined by using transaction prices paid to pharmacies by Medicaid agencies and managed care plans among prescriptions filled and dispensed in 2013. Outpatient medications accounted for 16.6% of all Medicaid expenditures. The 10 most expensive medication classes accounted for 63.9% of all medication expenditures. Stimulants (amphetamine-type) accounted for both the highest proportion of expenditures (20.6%) and days of medication use (14.0%) among medication classes. Users of medications in the 10 highest-expenditure classes were more likely to have a chronic condition of any complexity (77.9% vs 41.6%), a mental health condition (35.7% vs 11.9%), or a complex chronic condition (9.8% vs 4.3%) than other Medicaid enrollees (all P costs may benefit from better delineation of the appropriate prescription of these medications. Copyright © 2017 by the American Academy of Pediatrics.

Medicaid Coverage Expansions and Cigarette Smoking Cessation Among Low-income Adults.

Science.gov (United States)

Koma, Jonathan W; Donohue, Julie M; Barry, Colleen L; Huskamp, Haiden A; Jarlenski, Marian

2017-12-01

Expanding Medicaid coverage to low-income adults may have increased smoking cessation through improved access to evidence-based treatments. Our study sought to determine if states' decisions to expand Medicaid increased recent smoking cessation. Using pooled cross-sectional data from the Behavioral Risk Factor Surveillance Survey for the years 2011-2015, we examined the association between state Medicaid coverage and the probability of recent smoking cessation among low-income adults without dependent children who were current or former smokers (n=36,083). We used difference-in-differences estimation to examine the effects of Medicaid coverage on smoking cessation, comparing low-income adult smokers in states with Medicaid coverage to comparable adults in states without Medicaid coverage, with ages 18-64 years to those ages 65 years and above. Analyses were conducted for the full sample and stratified by sex. Residence in a state with Medicaid coverage among low-income adult smokers ages 18-64 years was associated with an increase in recent smoking cessation of 2.1 percentage points (95% confidence interval, 0.25-3.9). In the comparison group of individuals ages 65 years and above, residence in a state with Medicaid coverage expansion was not associated with a change in recent smoking cessation (-0.1 percentage point, 95% confidence interval, -2.1 to 1.8). Similar increases in smoking cessation among those ages 18-64 years were estimated for females and males (1.9 and 2.2 percentage point, respectively). Findings are consistent with the hypothesis that Medicaid coverage expansions may have increased smoking cessation among low-income adults without dependent children via greater access to preventive health care services, including evidence-based smoking cessation services.

Smoking prevalence in Medicaid has been declining at a negligible rate.

Directory of Open Access Journals (Sweden)

Shu-Hong Zhu

Full Text Available In recent decades the overall smoking prevalence in the US has fallen steadily. This study examines whether the same trend is seen in the Medicaid population.National Health Interview Survey (NHIS data from 17 consecutive annual surveys from 1997 to 2013 (combined N = 514,043 were used to compare smoking trends for 4 insurance groups: Medicaid, the Uninsured, Private Insurance, and Other Coverage. Rates of chronic disease and psychological distress were also compared.Adjusted smoking prevalence showed no detectable decline in the Medicaid population (from 33.8% in 1997 to 31.8% in 2013, trend test P = 0.13, while prevalence in the other insurance groups showed significant declines (38.6%-34.7% for the Uninsured, 21.3%-15.8% for Private Insurance, and 22.6%-16.8% for Other Coverage; all P's<0.005. Among individuals who have ever smoked, Medicaid recipients were less likely to have quit (38.8% than those in Private Insurance (62.3% or Other Coverage (69.8%; both P's<0.001. Smokers in Medicaid were more likely than those in Private Insurance and the Uninsured to have chronic disease (55.0% vs 37.3% and 32.4%, respectively; both P's<0.01. Smokers in Medicaid were also more likely to experience severe psychological distress (16.2% for Medicaid vs 3.2% for Private Insurance and 7.6% for the Uninsured; both P's<0.001.The high and relatively unchanging smoking prevalence in the Medicaid population, low quit ratio, and high rates of chronic disease and severe psychological distress highlight the need to focus on this population. A targeted and sustained campaign to help Medicaid recipients quit smoking is urgently needed.

Intergenerational enrollment and expenditure changes in Medicaid: trends from 1991 to 2005

Directory of Open Access Journals (Sweden)

Patrick Stephen W

2012-09-01

Full Text Available Abstract Background From its inception, Medicaid was aimed at providing insurance coverage for low income children, elderly, and disabled. Since this time, children have become a smaller proportion of the US population and Medicaid has expanded to additional eligibility groups. We sought to evaluate relative growth in spending in the Medicaid program between children and adults from 1991-2005. We hypothesize that this shifting demographic will result in fewer resources being allocated to children in the Medicaid program. Methods We utilized retrospective enrollment and expenditure data for children, adults and the elderly from 1991 to 2005 for both Medicaid and Children’s Health Insurance Program Medicaid expansion programs. Data were obtained from the Centers for Medicare and Medicaid Services using their Medicaid Statistical Information System. Results From 1991 to 2005, the number of enrollees increased by 83% to 58.7 million. This includes increases of 33% for children, 100% for adults and 50% for the elderly. Concurrently, total expenditures nationwide rose 150% to $273 billion. Expenditures for children increased from $23.4 to $65.7 billion, adults from $46.2 to $123.6 billion, and elderly from $39.2 to $71.3 billion. From 1999 to 2005, Medicaid spending on long-term care increased by 31% to $84.3 billion. Expenditures on the disabled grew by 61% to $119 billion. In total, the disabled account for 43% and long-term care 31%, of the total Medicaid budget. Conclusion Our study did not find an absolute decrease in the overall resources being directed toward children. However, increased spending on adults on a per-capita and absolute basis, particularly disabled adults, is responsible for much of the growth in spending over the past 15 years. Medicaid expenditures have grown faster than inflation and overall national health expenditures. A national strategy is needed to ensure adequate coverage for Medicaid recipients while dealing with the

42 CFR 460.124 - Additional appeal rights under Medicare or Medicaid.

Science.gov (United States)

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Additional appeal rights under Medicare or Medicaid. 460.124 Section 460.124 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH... or Medicaid. A PACE organization must inform a participant in writing of his or her appeal rights...

Fabrication of a roller type PDMS stamp using SU-8 concave molds and its application for roll contact printing

International Nuclear Information System (INIS)

Park, Jongho; Kim, Beomjoon

2016-01-01

Continuous fabrication of micropatterns at low-cost is attracting attention in various applications within industrial fields. To meet such demands, we have demonstrated a roll contact printing technique, using roller type polydimethylsiloxane (PDMS) stamps with roll-to-flat and roll-to-roll stages. Roller type PDMS stamps for roll contact printing were fabricated using a custom-made metal support and SU-8 microstructures fabricated on concave substrates as a mold. The molding/casting method which we developed here provided faster and easier fabrication than conventional methods for roller type stamps. Next, roll contact printing was performed using fabricated roller type PDMS stamps with roll-to-flat and roll-to-roll stages. Patterns with minimum widths of 3 μm and 2.1 μm were continuously fabricated for each stage, respectively. In addition, the relationship between applied pressures and dimensional changes of roll contact printed patterns was investigated. Finally, we confirmed that roll contact printing and the new fabrication method for roller stamps presented in this study demonstrated the feasibility for industrial applications. (paper)

Health Care Expenditures for Children with Autism Spectrum Disorders in Medicaid

Science.gov (United States)

Wang, Li; Leslie, Douglas L.

2010-01-01

Objective: To study trends in health care expenditures associated with autism spectrum disorders (ASDs) in state Medicaid programs. Method: Using Medicaid data from 42 states from 2000 to 2003, patients aged 17 years and under who were continuously enrolled in fee-for-service Medicaid were studied. Patients with claims related to autistic disorder…

42 CFR 455.21 - Cooperation with State Medicaid fraud control units.

Science.gov (United States)

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Cooperation with State Medicaid fraud control units... Detection and Investigation Program § 455.21 Cooperation with State Medicaid fraud control units. In a State with a Medicaid fraud control unit established and certified under subpart C of this part, (a) The...

design and development of a soap stamping and tableting machine

African Journals Online (AJOL)

2012-07-02

Jul 2, 2012 ... for these two operations. The manual ... chine, the cutting and stamping operations were done at different .... slack side belt tensions Tj were determined as 131.66N and 162.71N for the .... vironmental Management, Vol. 6, No.

The Role of Medicare's Inpatient Cost-Sharing in Medicaid Entry.

Science.gov (United States)

Keohane, Laura M; Trivedi, Amal N; Mor, Vincent

2018-04-01

To isolate the effect of greater inpatient cost-sharing on Medicaid entry among Medicare beneficiaries. Medicare administrative data (years 2007-2010) were linked to nursing home assessments and area-level socioeconomic indicators. Medicare beneficiaries who are readmitted to a hospital must pay an additional deductible ($1,100 in 2010) if their readmission occurs more than 59 days following discharge. In a regression discontinuity analysis, we take advantage of this Medicare benefit feature to test whether beneficiaries with greater cost-sharing have higher rates of Medicaid enrollment. We identified 221,248 Medicare beneficiaries with an initial hospital stay and a readmission 53-59 days later (no deductible) or 60-66 days later (charged a deductible). Among beneficiaries in low-socioeconomic areas with two hospitalizations, those readmitted 60-66 days after discharge were 21 percent more likely to join Medicaid compared with those readmitted 53-59 days following their initial hospitalization (absolute difference in adjusted risk of Medicaid entry: 3.7 percent vs. 3.1 percent, p = .01). Increasing Medicare cost-sharing requirements may promote Medicaid enrollment among low-income beneficiaries. Potential savings from an increased cost-sharing in the Medicare program may be offset by increased Medicaid participation. © Health Research and Educational Trust.

Pediatric Dentist Density and Preventive Care Utilization for Medicaid Children.

Science.gov (United States)

Heidenreich, James F; Kim, Amy S; Scott, JoAnna M; Chi, Donald L

2015-01-01

The purpose of this study was to evaluate county-level pediatric dentist density and dental care utilization for Medicaid-enrolled children. This was a cross-sectional analysis of 604,885 zero- to 17-year-olds enrolled in the Washington State Medicaid Program for 11-12 months in 2012. The relationship between county-level pediatric dentist density, defined as the number of pediatric dentists per 10,000 Medicaid-enrolled children, and preventive dental care utilization was evaluated using linear regression models. In 2012, 179 pediatric dentists practiced in 16 of the 39 counties in Washington. County-level pediatric dentist density varied from zero to 5.98 pediatric dentists per 10,000 Medicaid-enrolled children. County-level preventive dental care utilization ranged from 32 percent to 81 percent, with 62 percent of Medicaid-enrolled children utilizing preventive dental services. County-level density was significantly associated with county-level dental care utilization (Slope equals 1.67, 95 percent confidence interval equals 0.02, 3.32, Pchildren who utilize preventive dental care services. Policies aimed at improving pediatric oral health disparities should include strategies to increase the number of oral health care providers, including pediatric dentists, in geographic areas with large proportions of Medicaid-enrolled children.

Closing Kynect and Restructuring Medicaid Threaten Kentucky's Health and Economy.

Science.gov (United States)

Wright, Charles B; Vanderford, Nathan L

2017-08-01

Following passage of the Patient Protection and Affordable Care Act (ACA) in the United States, the Kentucky Health Benefit Exchange, Kynect, began operating in Kentucky in October 2013. Kentucky expanded Medicaid eligibility in January 2014. Together, Kynect and Medicaid expansion provided access to affordable health care coverage to hundreds of thousands of individuals in Kentucky. However, following the Kentucky gubernatorial election in 2015, the newly inaugurated governor moved to dismantle Kynect and restructure the Medicaid expansion, jeopardizing public health gains and the state economy. As the first state to announce both the closure and restructuring of a state health insurance marketplace and Medicaid expansion, Kentucky may serve as a test case for the rest of the nation for reversal of ACA-related health policies. This article describes Kynect and the Kentucky Medicaid expansion and examines the potential short-term and long-term impacts that may occur following changes in state health policy. Furthermore, this article will offer potential strategies to ameliorate the expected negative impacts of disruption of both Kynect and the Medicaid expansion, such as the creation of a new state insurance marketplace under a new governor, the implementation of a private option, and increasing the state minimum wage for workers. Copyright © 2017 by Duke University Press.

Early Childhood Caries and the Impact of Current U.S. Medicaid Program: An Overview

Directory of Open Access Journals (Sweden)

Bussma Ahmed Bugis

2012-01-01

Full Text Available Pediatric dental caries is the most common chronic disease among children. Above 40% of the U.S. children aged 2–11 years have dental caries; more than 50% of them come from low-income families. Under dental services of the Medicaid program, children enrolled in Medicaid must receive preventive dental services. However, only 1/5 of them utilize preventive dental services. The purpose of this overview is to measure the impact of Medicaid dental benefits on reducing oral health disparities among Medicaid-eligible children. This paper explains the importance of preventive dental care, children at high risk of dental caries, Medicaid dental benefits, utilization of dental preventive services by Medicaid-eligible children, dental utilization influencing factors, and outcome evaluation of Medicaid in preventing dental caries among children. In conclusion, despite the recent increase of children enrolled in Medicaid, utilizing preventive dental care is still a real challenge that faces Medicaid.

Neonatal Abstinence Syndrome: Trend and Expenditure in Louisiana Medicaid, 2003-2013.

Science.gov (United States)

Okoroh, Ekwutosi M; Gee, Rebekah E; Jiang, Baogong; McNeil, Melissa B; Hardy-Decuir, Beverly A; Zapata, Amy L

2017-07-01

Objectives Determine trends in incidence and expenditure for perinatal drug exposure and neonatal abstinence syndrome (NAS) among Louisiana's Medicaid population. We also describe the maternal characteristics of NAS affected infants. Methods Retrospective cohort analysis using linked Medicaid and vital records data from 2003 to 2013. Conducted incidence and cost trends for drug exposed infants with and without NAS. Also performed comparison statistics among drug exposed infants with and without NAS and those not drug exposed. Results As rate of perinatal drug exposure increased, NAS rate per 1000 live Medicaid births also increased, from 2.1 (2003) to 3.6 (2007) to 8.0 (2013) (P for trend Medicaid also increased from $1.3 million to $3.6 million to $8.7 million (P for trend Medicaid infants quadrupled and the cost for caring for the affected infants increased six-fold. Medicaid, as the predominant payer for pregnant women and children affected by substance use disorders, must play a more active role in expanding access to comprehensive substance abuse treatment programs.

Women Putting Our Stamp on America: Biographies and Activities for National Women's History Month, March 1999.

Science.gov (United States)

National Women's History Project, Windsor, CA.

This booklet, intended for use by educators and by workplace and community organizers, introduces women who have been featured on U.S. postage stamps as well as a few of the women who clearly merit such honor in the future. Postage stamps featuring women have been relatively few and far between and have only skimmed the surface of U.S. women in…

Draw-in Map - A Road Map for Simulation-Guided Die Tryout and Stamping Process Control

International Nuclear Information System (INIS)

Wang Chuantao; Zhang, Jimmy J.; Goan, Norman

2005-01-01

Sheet metal forming is a displacement or draw-in controlled manufacturing process in which a flat blank is drawn into die cavity to form an automotive body panel. Draw-in amount is the single most important stamping manufacturing index that controls all forming characteristics (strains, stresses, thinning, etc.), stamping failures (splits, wrinkles, surface distortion, etc.) and line die operations and automations. Draw-in Map is engineered for math-based die developments via advanced stamping simulation technology. Then the Draw-in Map is provided to die makers in plants as a road map for math-guided die tryout in which the die tryout workers follow the engineered tryout conditions and matches the engineered draw-in amount so that the tryout time and cost are greatly reduced, and quality is ensured. The Map can also be used as a math-based trouble-shooting tool to identify the causes of formability problems in stamping production. The engineered Draw-in Map has been applied to all draw die tryout for all GM vehicle programs since 1998. A minimum 50% reduction in both lead-time and cost and significant improvement in panel quality in tryout have been reported. This paper presents the concept and process to apply the engineered Draw-in Map in die tryout

Corrosion resistance characteristics of stamped and hydroformed proton exchange membrane fuel cell metallic bipolar plates

Energy Technology Data Exchange (ETDEWEB)

Dundar, F. [NSF I/UCRC Center for Precision Forming (CPF), Virginia Commonwealth University, Richmond, VA (United States); Department of Materials Science and Engineering, Gebze Institute of Technology (Turkey); Dur, Ender; Koc, M. [NSF I/UCRC Center for Precision Forming (CPF), Virginia Commonwealth University, Richmond, VA (United States); Mahabunphachai, S. [NSF I/UCRC Center for Precision Forming (CPF), Virginia Commonwealth University, Richmond, VA (United States); National Metal and Materials Technology Center (MTEC), Pathumthani (Thailand)

2010-06-01

Metallic bipolar plates have several advantages over bipolar plates made from graphite and composites due to their high conductivity, low material and production costs. Moreover, thin bipolar plates are possible with metallic alloys, and hence low fuel cell stack volume and mass are. Among existing fabrication methods for metallic bipolar plates, stamping and hydroforming are seen as prominent approaches for mass production scales. In this study, the effects of important process parameters of these manufacturing processes on the corrosion resistance of metallic bipolar plates made of SS304 were investigated. Specifically, the effects of punch speed, pressure rate, stamping force and hydroforming pressure were studied as they were considered to inevitably affect the bipolar plate micro-channel dimensions, surface topography, and hence the corrosion resistance. Corrosion resistance under real fuel cell conditions was examined using both potentiodynamic and potentiostatic experiments. The majority of the results exhibited a reduction in the corrosion resistance for both stamped and hydroformed plates when compared with non-deformed blank plates of SS304. In addition, it was observed that there exist an optimal process window for punch speed in stamping and the pressure rate in hydroforming to achieve improved corrosion resistance at a faster production rate. (author)

Medicaid spending on contraceptive coverage and pregnancy-related care

Science.gov (United States)

2014-01-01

Objective Up to 50% of pregnancies are unintended in the United States, and the healthcare costs associated with pregnancy are the most expensive among hospitalized conditions. The current study aims to assess Medicaid spending on various methods of contraception and on pregnancy care including unintended pregnancies. Methods We analyzed Medicaid health claims data from 2004 to 2010. Women 14–49 years of age initiating contraceptive methods and pregnant women were included as separate cohorts. Medicaid spending was summarized using mean all-cause and contraceptive healthcare payments per patient per month (PPPM) over a follow-up period of up to 12 months. Medicaid payments were also estimated in 2008 per female member of childbearing age per month (PFCPM) and per member per month (PMPM). Medicaid payments on unintended pregnancies were also evaluated PFCPM and PMPM in 2008. Results For short-acting reversible contraception (SARC) users, all-cause payments and contraceptive payments PPPM were respectively $365 and $18.3 for oral contraceptive (OC) users, $308 and $19.9 for transdermal users, $215 and $21.6 for vaginal ring users, and $410 and $8.8 for injectable users. For long-acting reversible contraception (LARC) users (follow-up of 9–10 months), corresponding payments were $194 and $36.8 for IUD users, and $237 and $29.9 for implant users. Pregnancy cohort all-cause mean healthcare payments PPPM were $610. Payments PFCPM and PMPM for contraceptives were $1.44 and $0.54, while corresponding costs of pregnancies were estimated at $39.91 and $14.81, respectively. Payments PFCPM and PMPM for contraceptives represented a small fraction at 6.56% ($1.44/$21.95) and 6.63% ($0.54/$8.15), respectively of the estimated payments for unintended pregnancy. Conclusions This study of a large sample of Medicaid beneficiaries demonstrated that, over a follow-up period of 12 months, Medicaid payments for pregnancy were considerably higher than payments for either SARC or

American Society of Mechanical Engineers' N stamp requirements

International Nuclear Information System (INIS)

Row, P.D.

1977-01-01

Incorporated with ASME Section III, Nuclear Power Plant Components, is an Appendix on Quality Assurance Systems which includes provision for ASME surveys. Manufacturers and installers passing the survey successfully receive an N Symbol Stamp and an ASME Certificate of Authorization. An outline is given of the prerequisites for a survey to be scheduled and of the requirements and procedures adopted by the survey team. (U.K.)

Effect of Al-Si Coating on Weld Microstructure and Properties of 22MnB5 Steel Joints for Hot Stamping

Science.gov (United States)

Lin, Wenhu; Li, Fang; Wu, Dongsheng; Chen, Xiaoguan; Hua, Xueming; Pan, Hua

2018-03-01

22MnB5 hot stamping steels are gradually being used in tailor-welded blank applications. In this experiment, 1-mm-thick Al-Si coated and de-coated 22MnB5 steels were laser-welded and then hot-stamped. The chemical compositions, solidification process, microstructure and mechanical properties were investigated to reveal the effect of Al-Si coating and heat treatment. In the welded condition, the coated joints had an Al content of approximately 2.5 wt.% in the fusion zone and the de-coated joints had 0.5 wt.% Al. The aluminum promoted the δ-ferrite formation as the skeletal structure during solidification. In the high-aluminum weld, the microstructure consisted of martensite and long and band-like δ-ferrite. Meanwhile, the low-aluminum weld was full of lath martensite. After the hot stamping process, the δ-ferrite fraction increased from 10 to 24% in the coated joints and the lath martensite became finer in the de-coated joints. The tensile strengths of the coated joints or de-coated joints were similar to that before hot stamping, but the strength of the coated joints was reduced heavily after hot stamping compared to the de-coated joints and base material. The effect of δ-ferrite on the tensile properties became stronger when the fusion zone was soft and deformed first in the hot-stamped specimens. The coated weld showed a brittle fracture surface with many cleavage planes, and the de-coated weld showed a ductile fracture surface with many dimples in hot-stamped conditions.

Medicare and Medicaid Statistical Supplement

Data.gov (United States)

U.S. Department of Health & Human Services — The CMS Office of Enterprise Data and Analytics (OEDA) produced an annual Medicare and Medicaid Statistical Supplement report providing detailed statistical...

Elsa Baxter, head of the Swiss Post Office's Stamps and Philately Unit, presents to Robert Aymar, CERN's Director-General, the Swiss commemorative stamp dedicated to CERN

CERN Multimedia

Patrice Loiez

2004-01-01

'I am delighted to offer you a special stamp which commemorates your Laboratory's fifty-year history and pays tribute to its achievements, its pioneering spirit and its perseverance' said Mrs Baxter to Robert Aymar, CERN's Director-General.

42 CFR 422.107 - Special needs plans and dual-eligibles: Contract with State Medicaid Agency.

Science.gov (United States)

2010-10-01

... with State Medicaid Agency. 422.107 Section 422.107 Public Health CENTERS FOR MEDICARE & MEDICAID... Medicaid Agency. (a) Definition. For the purpose of this section, a contract with a State Medicaid agency means a formal written agreement between an MA organization and the State Medicaid agency documenting...

The Oregon experiment--effects of Medicaid on clinical outcomes

NARCIS (Netherlands)

Baicker, K.; Taubman, S.L.; Allen, H.L.; Bernstein, M.; Gruber, J.H.; Newhouse, J.P.; Schneider, E.C.; Wright, B.J.; Zaslavsky, A.M.; Finkelstein, A.N.; Carlson, M.; Edlund, T.; Gallia, C.; Smith, J.; et al.,

2013-01-01

BACKGROUND: Despite the imminent expansion of Medicaid coverage for low-income adults, the effects of expanding coverage are unclear. The 2008 Medicaid expansion in Oregon based on lottery drawings from a waiting list provided an opportunity to evaluate these effects. METHODS: Approximately 2 years

Spillover Effects of Adult Medicaid Expansions on Children's Use of Preventive Services.

Science.gov (United States)

Venkataramani, Maya; Pollack, Craig Evan; Roberts, Eric T

2017-12-01

Since the passage of the Affordable Care Act, Medicaid enrollment has increased by ∼17 million adults, including many low-income parents. One potentially important, but little studied, consequence of expanding health insurance for parents is its effect on children's receipt of preventive services. By using state Medicaid eligibility thresholds linked to the 2001-2013 Medical Expenditure Panel Surveys, we assessed the relationship between changes in adult Medicaid eligibility and children's likelihood of receiving annual well-child visits (WCVs). In instrumental variable analyses, we used these changes in Medicaid eligibility to estimate the relationship between parental enrollment in Medicaid and children's receipt of WCVs. Our analytic sample consisted of 50 622 parent-child dyads in families with incomes Medicaid eligibility (measured relative to the federal poverty level) was associated with a 0.27 percentage point higher probability that a child received an annual WCV (95% confidence interval: 0.058 to 0.48 percentage points, P = .012). Instrumental variable analyses revealed that parental enrollment in Medicaid was associated with a 29 percentage point higher probability that their child received an annual WCV (95% confidence interval: 11 to 47 percentage points, P = .002). In our study, we demonstrate that Medicaid expansions targeted at low-income adults are associated with increased receipt of recommended pediatric preventive care for their children. This finding reveals an important spillover effect of parental insurance coverage that should be considered in future policy decisions surrounding adult Medicaid eligibility. Copyright © 2017 by the American Academy of Pediatrics.

Characterization of the interfacial heat transfer coefficient for hot stamping processes

Science.gov (United States)

Luan, Xi; Liu, Xiaochuan; Fang, Haomiao; Ji, Kang; El Fakir, Omer; Wang, LiLiang

2016-08-01

In hot stamping processes, the interfacial heat transfer coefficient (IHTC) between the forming tools and hot blank is an essential parameter which determines the quenching rate of the process and hence the resulting material microstructure. The present work focuses on the characterization of the IHTC between an aluminium alloy 7075-T6 blank and two different die materials, cast iron (G3500) and H13 die steel, at various contact pressures. It was found that the IHTC between AA7075 and cast iron had values 78.6% higher than that obtained between AA7075 and H13 die steel. Die materials and contact pressures had pronounced effects on the IHTC, suggesting that the IHTC can be used to guide the selection of stamping tool materials and the precise control of processing parameters.

Social Work’s Role in Medicaid Reform: A Qualitative Study

Science.gov (United States)

Wachman, Madeline; Manning, Leticia; Cohen, Alexander M.; Seifert, Robert W.; Jones, David K.; Fitzgerald, Therese; Nuzum, Rachel; Riley, Patricia

2017-01-01

Objectives. To critically analyze social work’s role in Medicaid reform. Methods. We conducted semistructured interviews with 46 stakeholders from 10 US states that use a range of Medicaid reform approaches. We identified participants using snowball and purposive sampling. We gathered data in 2016 and analyzed them using qualitative methods. Results. Multiple themes emerged: (1) social work participates in Medicaid reform through clinical practice, including care coordination and case management; (2) there is a gap between social work’s practice-level and systems-level involvement in Medicaid innovations; (3) factors hindering social work’s involvement in systems-level practice include lack of visibility, insufficient clarity on social work’s role and impact, and too few resources within professional organizations; and (4) social workers need more training in health transformation payment models and policy. Conclusions. Social workers have unique skills that are valuable to building health systems that promote population health and reduce health inequities. Although there is considerable opportunity for social work to increase its role in Medicaid reform, there is little social work involvement at the systems level. PMID:29236537

26 CFR 301.7209-1 - Unauthorized use or sale of stamps.

Science.gov (United States)

2010-04-01

..., transfers, takes or gives in exchange, or pledges or gives in pledge, except as authorized in the Code or in regulations made pursuant thereto, any stamp, coupon, ticket, book, or other device prescribed by the...

Investigations on the Hot Stamping of AW-7921-T4 Alloy Sheet

Directory of Open Access Journals (Sweden)

M. Kumar

2017-01-01

Full Text Available AW-7xxx alloys have been nowadays considered for greater light weighting potential in automotive industry due to its higher strength compared to AW-5xxx and AW-6xxx alloys. However, due to their lower formability the forming processes are still in development. This paper investigates one such forming process called hot stamping. The investigation started by carrying out hot tensile testing of an AW-7xxx alloy, that is, AW-7921 at temperatures between 350°C and 475°C, to measure the strength and formability. Formability was found to improve with increasing temperature and was sensitive to the strain rate. Dynamic recovery is considered as usual reason for the formability improvement. However, examining the precipitation states of the as-received condition and after hot stamping using differential scanning calorimetry (DSC, the dissolution of precipitates was also believed to contribute to this increase in formability. Following solution heat treatment there was no precipitation during cooling across the cooling rates investigated (5–10°C/s. Samples taken from parts hot stamped at 10 and 20 mm s−1 had similar yield strengths. A 3-step paint baking heat treatment yielded a higher postpaint baking strength than a single step treatment.

Medicaid Fraud Control Units (MFCU) Annual Spending and Performance Statistics

Data.gov (United States)

U.S. Department of Health & Human Services — Medicaid Fraud Control Units (MFCU or Unit) investigate and prosecute Medicaid fraud as well as patient abuse and neglect in health care facilities. OIG certifies,...

Medicaid Managed Care Enrollment Report

Data.gov (United States)

U.S. Department of Health & Human Services — This report is composed annually and profiles enrollment statistics on Medicaid managed care programs on a plan-specific level. This report also provides...

Medicaid Disenrollment Patterns Among Children Coming into Contact with Child Welfare Agencies.

Science.gov (United States)

Raghavan, Ramesh; Allaire, Benjamin T; Brown, Derek S; Ross, Raven E

2016-06-01

Objectives To examine retention of Medicaid coverage over time for children in the child welfare system. Methods We linked a national survey of children with histories of abuse and neglect to their Medicaid claims files from 36 states, and followed these children over a 4 year period. We estimated a Cox proportional hazards model on time to first disenrollment from Medicaid. Results Half of our sample (50 %) retained Medicaid coverage across 4 years of follow up. Most disenrollments occurred in year 4. Being 3-5 years of age and rural residence were associated with increased hazard of insurance loss. Fee-for-service Medicaid and other non-managed insurance arrangements were associated with a lower hazard of insurance loss. Conclusions for Practice A considerable number of children entering child environments seem to retain Medicaid coverage over multiple years. Finding ways to promote entry of child welfare-involved children into health insurance coverage will be critical to assure services for this highly vulnerable population.

Patient Experience Of Provider Refusal Of Medicaid Coverage And Its Implications.

Science.gov (United States)

Bhandari, Neeraj; Shi, Yunfeng; Jung, Kyoungrae

2016-01-01

Previous studies show that many physicians do not accept new patients with Medicaid coverage, but no study has examined Medicaid enrollees' actual experience of provider refusal of their coverage and its implications. Using the 2012 National Health Interview Survey, we estimate provider refusal of health insurance coverage reported by 23,992 adults with continuous coverage for the past 12 months. We find that among Medicaid enrollees, 6.73% reported their coverage being refused by a provider in 2012, a rate higher than that in Medicare and private insurance by 4.07 (p<.01) and 3.68 (p<.001) percentage points, respectively. Refusal of Medicaid coverage is associated with delaying needed care, using emergency room (ER) as a usual source of care, and perceiving current coverage as worse than last year. In view of the Affordable Care Act's (ACA) Medicaid expansion, future studies should continue monitoring enrollees' experience of coverage refusal.

Medicaid Enrollment - New Adult Group

Data.gov (United States)

U.S. Department of Health & Human Services — Total Medicaid Enrollees - VIII Group Break Out Report Reported on the CMS-64 The enrollment information is a state-reported count of unduplicated individuals...

Medicare and Medicaid Research Review

Data.gov (United States)

U.S. Department of Health & Human Services — The Centers for Medicare and Medicaid Services (CMS), Office of Information Products and Data Analysis (OIPDA), is pleased to present our journal, Medicare and...

The relationship of post-acute home care use to Medicaid utilization and expenditures.

Science.gov (United States)

Payne, Susan M C; DiGiuseppe, David L; Tilahun, Negussie

2002-06-01

To describe the use of post-acute home care (PAHC) and total Medicaid expenditures among hospitalized nonelderly adult Medicaid eligibles and to test whether health services utilization rates or total Medicaid expenditures were lower among Medicaid eligibles who used PAHC compared to those who did not. 5,299 Medicaid patients aged 18-64 discharged in 1992-1996 from 29 hospitals in the Cleveland Health Quality Choice (CHQC) project. Linked Ohio Medicaid claims and CHQC medical record abstract data. One stay per patient was randomly selected. Observational study. To control for treatment selection bias, we developed a model predicting the probability (propensity) a patient would be referred to PAHC, as a proxy for the patient's need for PAHC. We matched 430 patients who used Medicaid-covered PAHC ("USE") to patients who did not ("NO USE") by their propensity scores. Study outcomes were inpatient re-admission rates and days of stay (DOS), nursing home admission rates and DOS, and mean total Medicaid expenditures 90 and 180 days after discharge. Of 3,788 medical patients, 12.1 percent were referred to PAHC; 64 percent of those referred used PAHC. Of 1,511 surgical patients, 10.9 percent were referred; 99 percent of those referred used PAHC. In 430 pairs of patients matched by propensity score, mean total Medicaid expenditures within 90 days after discharge were $7,649 in the USE group and $5,761 in the NO USE group. Total Medicaid expenditures were significantly higher in the USE group compared to the NO USE group for medical patients after 180 days (p analysis indicates the results may be influenced by unmeasured variables, most likely functional status and/or care-giver support. Thirty-six percent of the medical patients referred to PAHC did not receive Medicaid-covered services. This suggests potential underuse among medical patients. The high post-discharge expenditures suggest opportunities for reducing costs through coordinating utilization or diverting it to

State Medicaid reimbursement for nursing homes, 1978-86

Science.gov (United States)

Swan, James H.; Harrington, Charlene; Grant, Leslie A.

1988-01-01

State Medicaid reimbursement methods and rates are reported for the period 1978-86 for skilled nursing and intermediate care facilities. A cross-sectional time series regression analysis of Medicaid reimbursement rates on methods showed that States using prospective class reimbursement had significantly lower rates for the period 1982-86. States using prospective facility-specific reimbursement methods had lower rates than retrospective methods in 1983-84. PMID:10312516

Nanostructured submicron block copolymer dots by sacrificial stamping: a potential preconcentration platform for locally resolved sensing, chemistry and cellular interactions

OpenAIRE

Hou, Peilong; Han, Weijia; Philippi, Michael; Schäfer, Helmut; Steinhart, Martin

2018-01-01

Classical contact lithography involves patterning of surfaces by embossing or by transfer of ink. We report direct lithographic transfer of parts of sacrificial stamps onto counterpart surfaces. Using sacrificial stamps consisting of the block copolymer polystyrene-block-poly(2-pyridine) (PS-b-P2VP), we deposited arrays of nanostructured submicron PS-b-P2VP dots with heights of about 100 nm onto silicon wafers and glass slides. The sacrificial PS-b-P2VP stamps were topographically patterned w...

Medicaid reimbursement, prenatal care and infant health.

Science.gov (United States)

Sonchak, Lyudmyla

2015-12-01

This paper evaluates the impact of state-level Medicaid reimbursement rates for obstetric care on prenatal care utilization across demographic groups. It also uses these rates as an instrumental variable to assess the importance of prenatal care on birth weight. The analysis is conducted using a unique dataset of Medicaid reimbursement rates and 2001-2010 Vital Statistics Natality data. Conditional on county fixed effects, the study finds a modest, but statistically significant positive relationship between Medicaid reimbursement rates and the number of prenatal visits obtained by pregnant women. Additionally, higher rates are associated with an increase in the probability of obtaining adequate care, as well as a reduction in the incidence of going without any prenatal care. However, the effect of an additional prenatal visit on birth weight is virtually zero for black disadvantaged mothers, while an additional visit yields a substantial increase in birth weight of over 20 g for white disadvantaged mothers. Copyright © 2015 Elsevier B.V. All rights reserved.

Size Effect Studies on Tensile Tests for Hot Stamping Steel

Science.gov (United States)

Chen, Xiaodu; Li, Yuanyuan; Han, Xianhong; Zhang, Junbo

2018-02-01

Tensile tests have been widely used to determine basic mechanical properties of materials. However, the properties measured may be related to geometrical factors of the tested samples especially for high-strength steels; this makes the properties' definitions and comparisons difficult. In this study, a series of tensile tests of ultra-high-strength hot-stamped steel were performed; the geometric shapes and sizes as well as the cutting direction were modified. The results demonstrate that the hot-stamped parts were isotropic and the cutting direction had no effect; the measured strengths were practically unrelated to the specimen geometries, including both size and shape. The elongations were slightly related to sample sizes within the studied range but highly depended on the sample shape, represented by the coefficient K. Such phenomena were analyzed and discussed based on microstructural observations and fracture morphologies. Moreover, two widely used elongation conversion equations, the Oliver formula and Barba's law, were introduced to verify their applicability, and a new interpolating function was developed and compared.

Experimental Validation for Hot Stamping Process by Using Taguchi Method

Science.gov (United States)

Fawzi Zamri, Mohd; Lim, Syh Kai; Razlan Yusoff, Ahmad

2016-02-01

Due to the demand for reduction in gas emissions, energy saving and producing safer vehicles has driven the development of Ultra High Strength Steel (UHSS) material. To strengthen UHSS material such as boron steel, it needed to undergo a process of hot stamping for heating at certain temperature and time. In this paper, Taguchi method is applied to determine the appropriate parameter of thickness, heating temperature and heating time to achieve optimum strength of boron steel. The experiment is conducted by using flat square shape of hot stamping tool with tensile dog bone as a blank product. Then, the value of tensile strength and hardness is measured as response. The results showed that the lower thickness, higher heating temperature and heating time give the higher strength and hardness for the final product. In conclusion, boron steel blank are able to achieve up to 1200 MPa tensile strength and 650 HV of hardness.

New Medicaid Enrollees See Health and Social Benefits in Pennsylvania's Expansion.

Science.gov (United States)

Hom, Jeffrey K; Wong, Charlene; Stillson, Christian; Zha, Jessica; Cannuscio, Carolyn C; Cahill, Rachel; Grande, David

2016-01-01

Understanding how new Medicaid enrollees are approaching their own health and health care in the shifting health care landscape of the Affordable Care Act has implications for future outreach and enrollment efforts, as well as service planning for this population. The objective of this study was to explore the health care experiences and expectations of new Medicaid expansion beneficiaries in the immediate post-enrollment period. We conducted semistructured, qualitative interviews with a random sample of 40 adults in Philadelphia who had completed an application for Medicaid through a comprehensive benefits organization after January 1, 2015, when the Medicaid expansion in Pennsylvania took effect. We conducted an inductive, applied thematic analysis of interview transcripts. The new Medicaid beneficiaries described especially high levels of pent-up demand for care. Dental care was a far more pressing and motivating concern than medical care. Preventive services were also frequently mentioned. Participants anticipated that insurance would reduce both stress and financial strain and improve their experience in the health care system by raising their social standing. Participants highly valued the support of telephone application counselors in the Medicaid enrollment process to overcome bureaucratic obstacles they had encountered in the past. Dental care and preventive services appear to be high priorities for new Medicaid enrollees. Telephone outreach and enrollment support services can be an effective way to overcome past experiences with administrative barriers. © The Author(s) 2016.

The Role of Data in Health Care Disparities in Medicaid...

Data.gov (United States)

U.S. Department of Health & Human Services — According to findings reported in The Role of Data in Health Care Disparities in Medicaid Managed Care, published in Volume 2, Issue 4 of the Medicare and Medicaid...

Medicaid HMO penetration and its mix: did increased penetration affect physician participation in urban markets?

Science.gov (United States)

Adams, E Kathleen; Herring, Bradley

2008-02-01

To use changes in Medicaid health maintenance organization (HMO) penetration across markets over time to test for effects on the extent of Medicaid participation among physicians and to test for differences in the effects of increased use of commercial versus Medicaid-dominant plans within the market. The nationally representative Community Tracking Study's Physician Survey for three periods (1996-1997, 1998-1999, and 2000-2001) on 29,866 physicians combined with Centers for Medicare and Medicaid Services (CMS) and InterStudy data. Market-level estimates of Medicaid HMO penetration are used to test for (1) any participation in Medicaid and (2) the degree to which physicians have an "open" (i.e., nonlimited) practice accepting new Medicaid patients. Models account for physician, firm, and local characteristics, Medicaid relative payment levels adjusted for geographic variation in practice costs, and market-level fixed effects. There is a positive effect of increases in commercial Medicaid HMO penetration on the odds of accepting new Medicaid patients among all physicians, and in particular, among office-based physicians. In contrast, there is no effect, positive or negative, from expanding the penetration of Medicaid-dominant HMO plans within the market. Increases in cost-adjusted Medicaid fees, relative to Medicare levels, were associated with increases in the odds of participation and of physicians having an "open" Medicaid practice. Provider characteristics that consistently lower participation among all physicians include being older, board certified, a U.S. graduate and a solo practitioner. The effects of Medicaid HMO penetration on physician participation vary by the type of plan. If states are able to attract and retain commercial plans, participation by office-based physicians is likely to increase in a way that opens existing practices to more new Medicaid patients. Other policy variables that affect participation include the presence of a federally

The Medicaid School Program: An Effective Public School and Private Sector Partnership

Science.gov (United States)

Mallett, Christopher A.

2013-01-01

Privatized service delivery within Medicaid has greatly increased over the past two decades. This public program-private sector collaboration is quite common today, with a majority of Medicaid recipients receiving services in this fashion; yet controversy remains. This article focuses on just one program within Medicaid, school-based services for…

Early Medicaid Expansion In Connecticut Stemmed The Growth In Hospital Uncompensated Care.

Science.gov (United States)

Nikpay, Sayeh; Buchmueller, Thomas; Levy, Helen

2015-07-01

As states continue to debate whether or not to expand Medicaid under the Affordable Care Act (ACA), a key consideration is the impact of expansion on the financial position of hospitals, including their burden of uncompensated care. Conclusive evidence from coverage expansions that occurred in 2014 is several years away. In the meantime, we analyzed the experience of hospitals in Connecticut, which expanded Medicaid coverage to a large number of childless adults in April 2010 under the ACA. Using hospital-level panel data from Medicare cost reports, we performed difference-in-differences analyses to compare the change in Medicaid volume and uncompensated care in the period 2007-13 in Connecticut to changes in other Northeastern states. We found that early Medicaid expansion in Connecticut was associated with an increase in Medicaid discharges of 7-9 percentage points, relative to a baseline rate of 11 percent, and an increase of 7-8 percentage points in Medicaid revenue as a share of total revenue, relative to a baseline share of 10 percent. Also, in contrast to the national and regional trends of increasing uncompensated care during this period, hospitals in Connecticut experienced no increase in uncompensated care. We conclude that uncompensated care in Connecticut was roughly one-third lower than what it would have been without early Medicaid expansion. The results suggest that ACA Medicaid expansions could reduce hospitals' uncompensated care burden. Project HOPE—The People-to-People Health Foundation, Inc.

42 CFR 1002.230 - Notification of State or local convictions of crimes against Medicaid.

Science.gov (United States)

2010-10-01

... crimes against Medicaid. 1002.230 Section 1002.230 Public Health OFFICE OF INSPECTOR GENERAL-HEALTH CARE... MEDICAID Notification to OIG of State or Local Convictions of Crimes Against Medicaid § 1002.230 Notification of State or local convictions of crimes against Medicaid. (a) The State agency must notify the OIG...

76 FR 48563 - Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-January Through March 2011...

Science.gov (United States)

2011-08-08

... Medicare and Medicaid Services Medicare and Medicaid Programs; Quarterly Listing of Program Issuances... Centers for Medicare & Medicaid Services [CMS-9066-NC] Medicare and Medicaid Programs; Quarterly Listing... Medicare & Medicaid Services (CMS), HHS. ACTION: Notice with comment period. SUMMARY: This quarterly notice...

Dental Care - Medicaid and Chip

Data.gov (United States)

U.S. Department of Health & Human Services — Dental health is an important part of peoples overall health. States are required to provide dental benefits to children covered by Medicaid and the Childrens Health...

TRICARE Applied Behavior Analysis (ABA) Benefit: Comparison with Medicaid and Commercial Benefits.

Science.gov (United States)

Maglione, Margaret; Kadiyala, Srikanth; Kress, Amii; Hastings, Jaime L; O'Hanlon, Claire E

2017-01-01

This study compared the Applied Behavior Analysis (ABA) benefit provided by TRICARE as an early intervention for autism spectrum disorder with similar benefits in Medicaid and commercial health insurance plans. The sponsor, the Office of the Under Secretary of Defense for Personnel and Readiness, was particularly interested in how a proposed TRICARE reimbursement rate decrease from $125 per hour to $68 per hour for ABA services performed by a Board Certified Behavior Analyst compared with reimbursement rates (defined as third-party payment to the service provider) in Medicaid and commercial health insurance plans. Information on ABA coverage in state Medicaid programs was collected from Medicaid state waiver databases; subsequently, Medicaid provider reimbursement data were collected from state Medicaid fee schedules. Applied Behavior Analysis provider reimbursement in the commercial health insurance system was estimated using Truven Health MarketScan® data. A weighted mean U.S. reimbursement rate was calculated for several services using cross-state information on the number of children diagnosed with autism spectrum disorder. Locations of potential provider shortages were also identified. Medicaid and commercial insurance reimbursement rates varied considerably across the United States. This project concluded that the proposed $68-per-hour reimbursement rate for services provided by a board certified analyst was more than 25 percent below the U.S. mean.

Stamping, Clapping and Chanting: An Ancient Learning Pathway?

Directory of Open Access Journals (Sweden)

Marion M. Long

2006-04-01

Full Text Available In this review I explore the effect of temporal integration as a means of improving learning in schoolchildren. I focus first on theorists that have linked physical activity with a positive effect on children’s learning and second to psychological studies that have established the existence of innate temporal patterns. These findings are related to a model of temporal integration that I have developed from Croce’s writings on aesthetics (1900. From philosophy to neurology, I discuss recent neurological findings relating to timing and conclude that an organ of temporal integration, regulation and coordination operates in the brain with respect to physical, intuitive and higher cognitive function. I link recent findings in neurophysiology to notably similar findings in recent biomusicological studies. The finding that humans have an involuntary physical response to loud, low-frequency sounds are attributed to an innate legacy of proto-music and proto-dance behaviour among hominids. I develop the model of temporal integration further by examining the literature on stamping and clapping patterns of ancient traditional dances in relation to Husserl’s writings on theoretical succession. From philosophy to pedagogy, I summarise the review by proposing stamping, clapping and chanting as a means of achieving improved temporal integration.

Prediction of Proper Temperatures for the Hot Stamping Process Based on the Kinetics Models

Science.gov (United States)

Samadian, P.; Parsa, M. H.; Mirzadeh, H.

2015-02-01

Nowadays, the application of kinetics models for predicting microstructures of steels subjected to thermo-mechanical treatments has increased to minimize direct experimentation, which is costly and time consuming. In the current work, the final microstructures of AISI 4140 steel sheets after the hot stamping process were predicted using the Kirkaldy and Li kinetics models combined with new thermodynamically based models in order for the determination of the appropriate process temperatures. In this way, the effect of deformation during hot stamping on the Ae3, Acm, and Ae1 temperatures was considered, and then the equilibrium volume fractions of phases at different temperatures were calculated. Moreover, the ferrite transformation rate equations of the Kirkaldy and Li models were modified by a term proposed by Åkerström to consider the influence of plastic deformation. Results showed that the modified Kirkaldy model is satisfactory for the determination of appropriate austenitization temperatures for the hot stamping process of AISI 4140 steel sheets because of agreeable microstructure predictions in comparison with the experimental observations.

Time stamp technique using a nuclear emulsion multi-stage shifter for gamma-ray telescope

International Nuclear Information System (INIS)

Takahashi, Satoru; Aoki, Shigeki; Rokujo, Hiroki; Hamada, Kaname; Komatsu, Masahiro; Morishima, Kunihiro; Nakamura, Mitsuhiro; Nakano, Toshiyuki; Niwa, Kimio; Sato, Osamu; Yoshioka, Teppei; Kodama, Koichi

2010-01-01

Nuclear emulsion has a potential use as a gamma-ray telescope with high angular resolution. For this application it is necessary to know the time when each track was recorded in the emulsion. In previous experiments using nuclear emulsion, various efforts were used to associate time to nuclear emulsion tracks and to improve the time resolution. Using a high speed readout system for nuclear emulsion together with a clock-based multi-stage emulsion shifter, we invented a technique to give a time-stamp to emulsion tracks and greatly improve the time resolution. A test experiment with a 2-stage shifter was used to demonstrate the principle of multi-stage shifting, and we achieved a time resolution 1.5 s for 12.1 h (about 1 part in 29 000) with the time stamp reliability 97% and the time stamp efficiency 98%. This multi-stage shifter can achieve the time resolution required for a gamma-ray telescope and can also be applied to another cosmic ray observations and accelerator experiments using nuclear emulsion.

Association of Expanded Medicaid Coverage With Hospital Length of Stay After Injury.

Science.gov (United States)

Holzmacher, Jeremy L; Townsend, Kerry; Seavey, Caleb; Gannon, Stephanie; Schroeder, Mary; Gondek, Stephen; Collins, Lois; Amdur, Richard L; Sarani, Babak

2017-10-01

The expansion of Medicaid eligibility under the Affordable Care Act is a state-level decision that affects how patients with traumatic injury (trauma patients) interact with locoregional health care systems. Washington, DC; Maryland; and Virginia represent 3 unique payer systems with liberal, moderate, and no Medicaid expansion, respectively, under the Affordable Care Act. Characterizing the association of Medicaid expansion with hospitalization after injury is vital in the disposition planning for these patients. To determine the association between expanded Medicaid eligibility under the Affordable Care Act and duration of hospitalization after injury. This retrospective cohort study included patients admitted from Virginia, Maryland, and Washington, DC, to a single level I trauma center. Data were collected from January 1, 2013, through March 6, 2016, in Virginia and Washington, DC, and from May 1, 2013, through March 6, 2016, in Maryland. All patients with Medicare or Medicaid coverage and all uninsured patients were included. Patients with private insurance, patients with severe head or pelvic injuries, and those who died during hospitalization were excluded. Hospital length of stay (LOS) and whether its association with patient insurance status varied by state of residence. A total of 2314 patients (1541 men [66.6%] and 773 women [33.4%]; mean [SD] age, 52.9 [22.8] years) were enrolled in the study. The uninsured rate in the Washington, DC, cohort (190 of 1699 [11.2%]) was significantly lower compared with rates in the Virginia (141 of 296 [47.6%]) or the Maryland (106 of 319 [33.2%]) cohort (P Medicaid vs non-Medicaid recipients varied significantly by state. For Medicaid recipients, mean LOS in Washington, DC, was significantly shorter (2.57 days; 95% CI, 2.36-2.79 days) than in Maryland (3.51 days; 95% CI, 2.81-4.38 days; P = .02) or Virginia (3.9 days; 95% CI, 2.79-5.45 days; P = .05). Expanded Medicaid eligibility is associated with shorter

Oregon's Coordinated Care Organizations and Their Effect on Prenatal Care Utilization Among Medicaid Enrollees.

Science.gov (United States)

Oakley, Lisa P; Harvey, S Marie; Yoon, Jangho; Luck, Jeff

2017-09-01

Introduction Previous studies indicate that inadequate prenatal care is more common among women covered by Medicaid compared with private insurance. Increasing the proportion of pregnant women who receive early and adequate prenatal care is a Healthy People 2020 goal. We examined the impact of the implementation of Oregon's accountable care organizations, Coordinated Care Organizations (CCOs), for Medicaid enrollees, on prenatal care utilization among Oregon women of reproductive age enrolled in Medicaid. Methods Using Medicaid eligibility data linked to unique birth records for 2011-2013, we used a pre-posttest treatment-control design that compared prenatal care utilization for women on Medicaid before and after CCO implementation to women never enrolled in Medicaid. Additional stratified analyses were conducted to explore differences in the effect of CCO implementation based on rurality, race, and ethnicity. Results After CCO implementation, mothers on Medicaid had a 13% increase in the odds of receiving first trimester care (OR 1.13, CI 1.04, 1.23). Non-Hispanic (OR 1.20, CI 1.09, 1.32), White (OR 1.20, CI 1.08, 1.33) and Asian (OR 2.03, CI 1.26, 3.27) women on Medicaid were more likely to receive initial prenatal care in the first trimester after CCO implementation and only Medicaid women in urban areas were more likely (OR 1.14, CI 1.05, 1.25) to initiate prenatal care in the first trimester. Conclusion Following Oregon's implementation of an innovative Medicaid coordinated care model, we found that women on Medicaid experienced a significant increase in receiving timely prenatal care.

Medicaid Drug Rebate Program Data

Data.gov (United States)

U.S. Department of Health & Human Services — Product Data for Drugs in the Medicaid Drug Rebate Program. The rebate drug product data file contains the active drugs that have been reported by participating drug...

45 CFR 235.70 - Prompt notice to child support or Medicaid agency.

Science.gov (United States)

2010-10-01

... 45 Public Welfare 2 2010-10-01 2010-10-01 false Prompt notice to child support or Medicaid agency... Medicaid agency. (a) A State plan under title IV-A of the Social Security Act must provide for prompt.... Prompt notice must also include all relevant information as prescribed by the State medicaid agency for...

Reforming Access: Trends in Medicaid Enrollment for New Medicare Beneficiaries, 2008-2011.

Science.gov (United States)

Keohane, Laura M; Rahman, Momotazur; Mor, Vincent

2016-04-01

To evaluate whether aligning the Part D low-income subsidy and Medicaid program enrollment pathways in 2010 increased Medicaid participation among new Medicare beneficiaries. Medicare enrollment records for years 2007-2011. We used a multinomial logistic model with state fixed effects to examine the annual change in limited and full Medicaid enrollment among new Medicare beneficiaries for 2 years before and after the reforms (2008-2011). We identified new Medicare beneficiaries in the years 2008-2011 and their participation in Medicaid based on Medicare enrollment records. The percentage of beneficiaries enrolling in limited Medicaid at the start of Medicare coverage increased in 2010 by 0.3 percentage points for individuals aging into Medicare and by 1.3 percentage points for those qualifying due to disability (p < .001). There was no significant difference in the size of enrollment increases between states with and without concurrent limited Medicaid eligibility expansions. Our findings suggest that streamlining financial assistance programs may improve Medicare beneficiaries' access to benefits. © Health Research and Educational Trust.

42 CFR 422.106 - Coordination of benefits with employer or union group health plans and Medicaid.

Science.gov (United States)

2010-10-01

... group health plans and Medicaid. 422.106 Section 422.106 Public Health CENTERS FOR MEDICARE & MEDICAID... plans and Medicaid. (a) General rule. If an MA organization contracts with an employer, labor... enrollees in an MA plan, or contracts with a State Medicaid agency to provide Medicaid benefits to...

Transfer printing of 3D hierarchical gold structures using a sequentially imprinted polymer stamp

International Nuclear Information System (INIS)

Zhang Fengxiang; Low, Hong Yee

2008-01-01

Complex three-dimensional (3D) hierarchical structures on polymeric materials are fabricated through a process referred to as sequential imprinting. In this work, the sequentially imprinted polystyrene film is used as a soft stamp to replicate hierarchical structures onto gold (Au) films, and the Au structures are then transferred to a substrate by transfer printing at an elevated temperature and pressure. Continuous and isolated 3D structures can be selectively fabricated with the assistance of thermo-mechanical deformation of the polymer stamp. Hierarchical Au structures are achieved without the need for a corresponding three-dimensionally patterned mold

Stochastic analysis and robust optimization for a deck lid inner panel stamping

International Nuclear Information System (INIS)

Hou, Bo; Wang, Wurong; Li, Shuhui; Lin, Zhongqin; Xia, Z. Cedric

2010-01-01

FE-simulation and optimization are widely used in the stamping process to improve design quality and shorten development cycle. However, the current simulation and optimization may lead to non-robust results due to not considering the variation of material and process parameters. In this study, a novel stochastic analysis and robust optimization approach is proposed to improve the stamping robustness, where the uncertainties are involved to reflect manufacturing reality. A meta-model based stochastic analysis method is developed, where FE-simulation, uniform design and response surface methodology (RSM) are used to construct meta-model, based on which Monte-Carlo simulation is performed to predict the influence of input parameters variation on the final product quality. By applying the stochastic analysis, uniform design and RSM, the mean and the standard deviation (SD) of product quality are calculated as functions of the controllable process parameters. The robust optimization model composed of mean and SD is constructed and solved, the result of which is compared with the deterministic one to show its advantages. It is demonstrated that the product quality variations are reduced significantly, and quality targets (reject rate) are achieved under the robust optimal solution. The developed approach offers rapid and reliable results for engineers to deal with potential stamping problems during the early phase of product and tooling design, saving more time and resources.

Causal Analysis to a Subway Accident: A Comparison of STAMP and RAIB

Directory of Open Access Journals (Sweden)

Zhou Yao

2018-01-01

Full Text Available Accident investigation and analysis after the accident, vital to prevent the occurrence of similar accident and improve the safety of the system. Different methods led to a different understanding of the accident. In this paper, a subway accident was analysed with a systemic accident analysis model – STAMP (System-Theoretic Accident Modelling and Processes. The hierarchical safety control structure was obtained, and the system-level safety constraints were obtained, controllers of the physical layer were analysed one by one, and put forward the relevant safety requirements and constraints, the dynamic analysis of the structure of the safety control is carried out, and the targeted recommendations are pointed out. In comparison with the analysis results obtained by the Rail Accident Investigation Branch (RAIB. Some useful findings have been concluded. STAMP treats safety as a control problem and reduces or eliminates causes of the accident from the controlling perspective. Whereas RAIB obtains causes of the accident by analysing the sequence of events related to the accident and reasons of these events, then chooses one(or moreevent(s as the immediate cause and some of the key events as causal factors. RAIB analysis is based on the sequential event models, but STAMP analysis provides us with a holistic, dynamic way to control system to maintain safety.

Discrimination between authentic and false tax stamps from liquor bottles using laser-induced breakdown spectroscopy and chemometrics

International Nuclear Information System (INIS)

Gonzaga, Fabiano Barbieri; Rocha, Werickson Fortunato de Carvalho; Correa, Deleon Nascimento

2015-01-01

This work describes the preliminary application of a compact and low-cost laser-induced breakdown spectroscopy (LIBS) instrument for falsification detection of tax stamps used in alcoholic beverages. The new instrument was based on a diode-pumped passively Q-switched Nd:YLF microchip laser and a mini-spectrometer containing a Czerny–Turner polichromator coupled to a non-intensified, non-gated, and non-cooled 2048 pixel linear sensor array (200 to 850 nm spectral range). Twenty-three tax stamp samples were analyzed by firing laser pulses within two different regions of each sample: a hologram and a blank paper region. For each acquired spectrum, the emitted radiation was integrated for 3000 ms under the continuous application of laser pulses at 100 Hz (integration of 300 plasmas). Principal component analysis (PCA) or hierarchical cluster analysis (HCA) of all emission spectra from the hologram or blank paper region revealed two well-defined groups of authentic and false samples. Moreover, for the hologram data, three subgroups of false samples were found. Additionally, partial least squares discriminant analysis (PLS-DA) was successfully applied for the detection of the false tax stamps using all emission spectra from hologram or blank paper region. The discrimination between the samples was mostly ascribed to different levels of calcium concentration in the samples. - Highlights: • Compact and low-cost laser-induced breakdown spectrometer • Analysis of tax stamps used in alcoholic beverages • Detection of false tax stamps using the LIBS spectra and chemometrics • Falsification detection ascribed to different levels of calcium concentration

Discrimination between authentic and false tax stamps from liquor bottles using laser-induced breakdown spectroscopy and chemometrics

Energy Technology Data Exchange (ETDEWEB)

Gonzaga, Fabiano Barbieri, E-mail: fbgonzaga@inmetro.gov.br [Chemical Metrology Division, National Institute of Metrology, Quality and Technology (INMETRO), Av. Nossa Senhora das Graças, 50, Xerém, 25250-020 Duque de Caxias, RJ (Brazil); Rocha, Werickson Fortunato de Carvalho [Chemical Metrology Division, National Institute of Metrology, Quality and Technology (INMETRO), Av. Nossa Senhora das Graças, 50, Xerém, 25250-020 Duque de Caxias, RJ (Brazil); Correa, Deleon Nascimento [Technical–Scientific Police Superintendency, Criminalistic Institute Dr. Octávio Eduardo de Brito Alvarenga—IC-SPTC-SP, 05507-060 São Paulo, SP (Brazil)

2015-07-01

This work describes the preliminary application of a compact and low-cost laser-induced breakdown spectroscopy (LIBS) instrument for falsification detection of tax stamps used in alcoholic beverages. The new instrument was based on a diode-pumped passively Q-switched Nd:YLF microchip laser and a mini-spectrometer containing a Czerny–Turner polichromator coupled to a non-intensified, non-gated, and non-cooled 2048 pixel linear sensor array (200 to 850 nm spectral range). Twenty-three tax stamp samples were analyzed by firing laser pulses within two different regions of each sample: a hologram and a blank paper region. For each acquired spectrum, the emitted radiation was integrated for 3000 ms under the continuous application of laser pulses at 100 Hz (integration of 300 plasmas). Principal component analysis (PCA) or hierarchical cluster analysis (HCA) of all emission spectra from the hologram or blank paper region revealed two well-defined groups of authentic and false samples. Moreover, for the hologram data, three subgroups of false samples were found. Additionally, partial least squares discriminant analysis (PLS-DA) was successfully applied for the detection of the false tax stamps using all emission spectra from hologram or blank paper region. The discrimination between the samples was mostly ascribed to different levels of calcium concentration in the samples. - Highlights: • Compact and low-cost laser-induced breakdown spectrometer • Analysis of tax stamps used in alcoholic beverages • Detection of false tax stamps using the LIBS spectra and chemometrics • Falsification detection ascribed to different levels of calcium concentration.

Early-life Medicaid Coverage and Intergenerational Economic Mobility.

Science.gov (United States)

O'Brien, Rourke L; Robertson, Cassandra L

2018-04-01

New data reveal significant variation in economic mobility outcomes across U.S. localities. This suggests that social structures, institutions, and public policies-particularly those that influence critical early-life environments-play an important role in shaping mobility processes. Using new county-level estimates of intergenerational economic mobility for children born between 1980 and 1986, we exploit the uneven expansions of Medicaid eligibility across states to isolate the causal effect of this specific policy change on mobility outcomes. Instrumental-variable regression models reveal that increasing the proportion of low-income pregnant women eligible for Medicaid improved the mobility outcomes of their children in adulthood. We find no evidence that Medicaid coverage in later childhood years influences mobility outcomes. This study has implications for the normative evaluation of this policy intervention as well as our understanding of mobility processes in an era of rising inequality.

75 FR 56946 - Medicaid Program; Review and Approval Process for Section 1115 Demonstrations

Science.gov (United States)

2010-09-17

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Part 431 [CMS-2325-P] RIN 0938-AQ46 Medicaid Program; Review and Approval Process for Section 1115 Demonstrations AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Proposed rule. SUMMARY: This...

Low temperature high density plasma nitriding of stainless steel molds for stamping of oxide glasses

Directory of Open Access Journals (Sweden)

Aizawa Tatsuhiko

2016-01-01

Full Text Available Various kinds of stainless steels have been widely utilized as a die for mold- and direct-stamping processes of optical oxide glasses. Since they suffered from high temperature transients and thermal cycles in practice, they must be surface-treated by dry and wet coatings, or, by plasma nitriding. Martensitic stainless steel mold was first wet plated by the nickel phosphate (NiP, which was unstable at the high temperature stamping condition; and, was easy to crystalize or to fracture by itself. This issue of nuisance significantly lowered the productivity in fabrication of optical oxide-glass elements. In the present paper, the stainless steel mold was surface-treated by the low-temperature plasma nitriding. The nitrided layer by this surface modification had higher nitrogen solute content than 4 mass%; the maximum solid-solubility of nitrogen is usually 0.1 mass% in the equilibrium phase diagram. Owing to this solid-solution with high nitrogen concentration, the nitrided layer had high hardness over 1400 HV within its thickness of 50 μm without any formation of nitrides after plasma nitriding at 693 K for 14.4 ks. This plasma-nitrided mold was utilized for mold-stamping of two colored oxide glass plates at 833 K; these plates were successfully deformed and joined into a single glass plate by this stamping without adhesion or galling of oxide glasses onto the nitrided mold surface.

The impact of changing medicaid enrollments on New Mexico's Immunization Program.

Directory of Open Access Journals (Sweden)

Michael A Schillaci

Full Text Available Immunizations are an important component to pediatric primary care. New Mexico is a relatively poor and rural state which has sometimes struggled to achieve and maintain its childhood immunization rates. We evaluated New Mexico's immunization rates between 1996 and 2006. Specifically, we examined the increase in immunization rates between 2002 and 2004, and how this increase may have been associated with Medicaid enrollment levels, as opposed to changes in government policies concerning immunization practices.This study examines trends in childhood immunization coverage rates relative to Medicaid enrollment among those receiving Temporary Assistance for Needy Families (TANF in New Mexico. Information on health policy changes and immunization coverage was obtained from state governmental sources and the National Immunization Survey. We found statistically significant correlations varying from 0.86 to 0.93 between immunization rates and Medicaid enrollment.New Mexico's improvement and subsequent deterioration in immunization rates corresponded with changing Medicaid coverage, rather than the state's efforts to change immunization practices. Maintaining high Medicaid enrollment levels may be important for achieving high childhood immunization levels.

The Impact of Changing Medicaid Enrollments on New Mexico's Immunization Program

Science.gov (United States)

Schillaci, Michael A.; Waitzkin, Howard; Sharmen, Tom; Romain, Sandra J.

2008-01-01

Background Immunizations are an important component to pediatric primary care. New Mexico is a relatively poor and rural state which has sometimes struggled to achieve and maintain its childhood immunization rates. We evaluated New Mexico's immunization rates between 1996 and 2006. Specifically, we examined the increase in immunization rates between 2002 and 2004, and how this increase may have been associated with Medicaid enrollment levels, as opposed to changes in government policies concerning immunization practices. Methods and Findings This study examines trends in childhood immunization coverage rates relative to Medicaid enrollment among those receiving Temporary Assistance for Needy Families (TANF) in New Mexico. Information on health policy changes and immunization coverage was obtained from state governmental sources and the National Immunization Survey. We found statistically significant correlations varying from 0.86 to 0.93 between immunization rates and Medicaid enrollment. Conclusions New Mexico's improvement and subsequent deterioration in immunization rates corresponded with changing Medicaid coverage, rather than the state's efforts to change immunization practices. Maintaining high Medicaid enrollment levels may be important for achieving high childhood immunization levels. PMID:19107189

Medicare: Comparison of Catastrophic Health Insurance Proposals--An Update. Briefing Report to the Chairman, Select Committee on Aging, House of Representatives.

Science.gov (United States)

General Accounting Office, Washington, DC. Div. of Human Resources.

This document updates a recent report by the General Accounting Office (GAO) which compared Medicare catastrophic health insurance proposals. The update includes H.R. 2470, as passed by the House of Representatives and S. 1127, as reported by the Senate Committee on Finance. An introduction explains the roles of Medicare, Medicaid, the Veterans…

Polymer microlens replication by Nanoimprint Lithography using proton beam fabricated Ni stamp

International Nuclear Information System (INIS)

Dutta, R.K.; Kan, J.A. van; Bettiol, A.A.; Watt, F.

2007-01-01

It is essential to have a simplified and a rapid method for fabricating micro/nano structures in different kinds of polymeric materials. Though it is possible to fabricate arrays of microlens directly by P beam writing (PBW), it is restricted to a few types of resist materials. Therefore we have fabricated a Ni electroplated metallic stamp comprising of arrays of inverse/negative features of microlenses. The metallic stamp of about 500 μm thick is made on a silicon wafer coated with 10 μm thick polymethylglutarimide (PMGI) resist and the desired structures are written by PBW followed by thermal reflow and Ni electroplating. An array of microlenses is imprinted on a polycarbonate (PC) substrate by the Nanoimprint Lithography (NIL) technique and the replicated microlenses featuring various numerical apertures, diameters and pitches are characterized

Medical Expenditures Associated With Diabetes Among Youth With Medicaid Coverage.

Science.gov (United States)

Shrestha, Sundar S; Zhang, Ping; Thompson, Theodore J; Gregg, Edward W; Albright, Ann; Imperatore, Giuseppina

2017-07-01

Information on diabetes-related excess medical expenditures for youth is important to understand the magnitude of financial burden and to plan the health care resources needed for managing diabetes. However, diabetes-related excess medical expenditures for youth covered by Medicaid program have not been investigated recently. To estimate excess diabetes-related medical expenditures among youth aged below 20 years enrolled in Medicaid programs in the United States. We analyzed data from 2008 to 2012 MarketScan multistate Medicaid database for 6502 youths with diagnosed diabetes and 6502 propensity score matched youths without diabetes, enrolled in fee-for-service payment plans. We stratified analysis by Medicaid eligibility criteria (poverty or disability). We used 2-part regression models to estimate diabetes-related excess medical expenditures, adjusted for age, sex, race/ethnicity, year of claims, depression status, asthma status, and interaction terms. For poverty-based Medicaid enrollees, estimated annual diabetes-related total medical expenditure was $9046 per person [$3681 (no diabetes) vs. $12,727 (diabetes); PMedicaid enrollees, the estimated annual diabetes-related total medical expenditure was $9944 per person ($14,149 vs. $24,093; PMedicaid programs are substantial, which is larger among those with disabilities than without disabilities. Identifying cost-effective ways of managing diabetes in this vulnerable segment of the youth population is needed.

76 FR 28196 - Medicare and Medicaid Programs; Opportunities for Alignment Under Medicaid and Medicare

Science.gov (United States)

2011-05-16

... partner with States, providers, beneficiaries and their caregivers, and other stakeholders to improve... conflicting Medicaid and Medicare requirements. This document represents the first step. We have compiled what.... We will then determine which issues to address and in what order and timeframe. All areas are...

76 FR 14637 - State Medicaid Fraud Control Units; Data Mining

Science.gov (United States)

2011-03-17

...] State Medicaid Fraud Control Units; Data Mining AGENCY: Office of Inspector General (OIG), HHS. ACTION... and analyzing State Medicaid claims data, known as data mining. To support and modernize MFCU efforts... (FFP) in the costs of defined data mining activities under specified conditions. In addition, we...

The Effect of Medicaid Expansion on Utilization in Maryland Emergency Departments.

Science.gov (United States)

Klein, Eili Y; Levin, Scott; Toerper, Matthew F; Makowsky, Michael D; Xu, Tim; Cole, Gai; Kelen, Gabor D

2017-11-01

A proposed benefit of expanding Medicaid eligibility under the Patient Protection and Affordable Care Act (ACA) was a reduction in emergency department (ED) utilization for primary care needs. Pre-ACA studies found that new Medicaid enrollees increased their ED utilization rates, but the effect on system-level ED visits was less clear. Our objective was to estimate the effect of Medicaid expansion on aggregate and individual-based ED utilization patterns within Maryland. We performed a retrospective cross-sectional study of ED utilization patterns across Maryland, using data from Maryland's Health Services Cost Review Commission. We also analyzed utilization differences between pre-ACA (July 2012 to December 2013) uninsured patients who returned post-ACA (July 2014 to December 2015). The total number of ED visits in Maryland decreased by 36,531 (-1.2%) between the 6 quarters pre-ACA and the 6 quarters post-ACA. Medicaid-covered ED visits increased from 23.3% to 28.9% (159,004 additional visits), whereas uninsured patient visits decreased from 16.3% to 10.4% (181,607 fewer visits). Coverage by other insurance types remained largely stable between periods. We found no significant relationship between Medicaid expansion and changes in ED volume by hospital. For patients uninsured pre-ACA who returned post-ACA, the adjusted visits per person during 6 quarters was 2.38 (95% confidence interval 2.35 to 2.40) for those newly enrolled in Medicaid post-ACA compared with 1.66 (95% confidence interval 1.64 to 1.68) for those remaining uninsured. There was a substantial increase in patients covered by Medicaid in the post-ACA period, but this did not significantly affect total ED volume. Returning patients newly enrolled in Medicaid visited the ED more than their uninsured counterparts; however, this cohort accounted for only a small percentage of total ED visits in Maryland. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights

Federal Funding Insulated State Budgets From Increased Spending Related To Medicaid Expansion.

Science.gov (United States)

Sommers, Benjamin D; Gruber, Jonathan

2017-05-01

As states weigh whether to expand Medicaid under the Affordable Care Act (ACA) and Medicaid reform remains a priority for some federal lawmakers, fiscal considerations loom large. As part of the ACA's expansion of eligibility for Medicaid, the federal government paid for 100 percent of the costs for newly eligible Medicaid enrollees for the period 2014-16. In 2017 states will pay some of the costs for new enrollees, with each participating state's share rising to 10 percent by 2020. States continue to pay their traditional Medicaid share (roughly 25-50 percent, depending on the state) for previously eligible enrollees. We used data for fiscal years 2010-15 from the National Association of State Budget Officers and a difference-in-differences framework to assess the effects of the expansion's first two fiscal years. We found that the expansion led to an 11.7 percent increase in overall spending on Medicaid, which was accompanied by a 12.2 percent increase in spending from federal funds. There were no significant increases in spending from state funds as a result of the expansion, nor any significant reductions in spending on education or other programs. States' advance budget projections were also reasonably accurate in the aggregate, with no significant differences between the projected levels of federal, state, and Medicaid spending and the actual expenses as measured at the end of the fiscal year. Project HOPE—The People-to-People Health Foundation, Inc.

78 FR 72089 - Medicare, Medicaid, and Children's Health Insurance Programs; Provider Enrollment Application Fee...

Science.gov (United States)

2013-12-02

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-6051-N] Medicare, Medicaid, and Children's Health Insurance Programs; Provider Enrollment Application Fee Amount... period entitled ``Medicare, Medicaid, and Children's Health Insurance Programs; Additional Screening...

Poor program's progress: the unanticipated politics of Medicaid policy.

Science.gov (United States)

Brown, Lawrence D; Sparer, Michael S

2003-01-01

Advocates of U.S. national health insurance tend to share an image that highlights universal standards of coverage, social insurance financing, and national administration--in short, the basic features of Medicare. Such an approach is said to be good (equitable and efficient) policy and equally good politics. Medicaid, by contrast, is often taken to exemplify poor policy and poorer politics: means-tested eligibility, general revenue financing, and federal/state administration, which encourage inequities and disparities of care. This stark juxtaposition fails, however, to address important counterintuitive elements in the political evolution of these programs. Medicare's benefits and beneficiaries have stayed disturbingly stable, but Medicaid's relatively broad benefits have held firm, and its categories of beneficiaries have expanded. Repeated alarms about "bankruptcy" have undermined confidence in Medicare's trust funding, while Medicaid's claims on the taxpayer's dollar have worn well. Medicare's national administration has avoided disparities, but at the price of sacrificing state and local flexibility that can ease such "reforms" as the introduction of managed care. That Medicaid has fared better than a "poor people's program" supposedly could has provocative implications for health reform debates.

Global city aspirations, graduated citizenship and public housing: analysing the consumer citizenships of neoliberalism

Directory of Open Access Journals (Sweden)

Dallas Rogers

2014-01-01

Full Text Available Global city discourses rearticulate the relationships between the state, urban space and the global economy. At the local level, global city reconfigurations stamp the mark of a global economic order onto local citizenship practices. Public housing is a legacy of specific national (welfare states where citizenship rights arose from territorially bound constitutional discourses, and is incompatible in its current form with the consumer-based rights and responsibilities of a global economic order. At the same time, property markets in high-value areas of cities like Sydney, Australia, see not only increasing presence of international investment but fundamental changes in planning and governance processes in order to facilitate it. Global market-oriented discourses of urban governance promote consumer “performances of citizenship” and a graduated approach to the distribution of rights, including the right to housing. In this article we explore what is new about neoliberal approaches to public and social housing policy, and how public tenants respond to and negotiate it. In Australia tenants’ right to participate in local-level democracy, and in housing management, must be reconsidered in light of the broader discourses of consumer citizenship that are now enforced on tenants as a set of “responsibilities” to the market and state.

Disruption of Ttll5/stamp gene (tubulin tyrosine ligase-like protein 5/SRC-1 and TIF2-associated modulatory protein gene) in male mice causes sperm malformation and infertility.

Science.gov (United States)

Lee, Geun-Shik; He, Yuanzheng; Dougherty, Edward J; Jimenez-Movilla, Maria; Avella, Matteo; Grullon, Sean; Sharlin, David S; Guo, Chunhua; Blackford, John A; Awasthi, Smita; Zhang, Zhenhuan; Armstrong, Stephen P; London, Edra C; Chen, Weiping; Dean, Jurrien; Simons, S Stoney

2013-05-24

TTLL5/STAMP (tubulin tyrosine ligase-like family member 5) has multiple activities in cells. TTLL5 is one of 13 TTLLs, has polyglutamylation activity, augments the activity of p160 coactivators (SRC-1 and TIF2) in glucocorticoid receptor-regulated gene induction and repression, and displays steroid-independent growth activity with several cell types. To examine TTLL5/STAMP functions in whole animals, mice were prepared with an internal deletion that eliminated several activities of the Stamp gene. This mutation causes both reduced levels of STAMP mRNA and C-terminal truncation of STAMP protein. Homozygous targeted mutant (Stamp(tm/tm)) mice appear normal except for marked decreases in male fertility associated with defects in progressive sperm motility. Abnormal axonemal structures with loss of tubulin doublets occur in most Stamp(tm/tm) sperm tails in conjunction with substantial reduction in α-tubulin polyglutamylation, which closely correlates with the reduction in mutant STAMP mRNA. The axonemes in other structures appear unaffected. There is no obvious change in the organs for sperm development of WT versus Stamp(tm/tm) males despite the levels of WT STAMP mRNA in testes being 20-fold higher than in any other organ examined. This defect in male fertility is unrelated to other Ttll genes or 24 genes previously identified as important for sperm function. Thus, STAMP appears to participate in a unique, tissue-selective TTLL-mediated pathway for α-tubulin polyglutamylation that is required for sperm maturation and motility and may be relevant for male fertility.

Medicare-Medicaid Eligible Beneficiaries and Potentiall...

Data.gov (United States)

U.S. Department of Health & Human Services — More than one in four hospitalizations for those with both Medicare and full Medicaid coverage was potentially avoidable, according to findings reported in...

Wisconsins Experience with Medicaid Auto Enrollment

Data.gov (United States)

U.S. Department of Health & Human Services — The Patient Protection and Affordable Care Act (ACA) relies heavily on the expansion of Medicaid eligibility to cover uninsured populations. In February 2008,...

Studying the Solar System Can Be More than Just "Stamp Collecting"

Science.gov (United States)

LoPresto, Michael C.

2017-01-01

While teaching his first-ever introductory college astronomy course, I heard a graduate student make the comment that compared to other areas of astronomy, studying the solar system is just "stamp collecting." Coverage of the solar system in an introductory college astronomy course certainly "could" consist mostly of showing…

Medicaid Coverage for Methadone Maintenance and Use of Opioid Agonist Therapy in Specialty Addiction Treatment.

Science.gov (United States)

Saloner, Brendan; Stoller, Kenneth B; Barry, Colleen L

2016-06-01

This study examined differences in opioid agonist therapy (OAT) utilization among Medicaid-enrolled adults receiving public-sector opioid use disorder treatment in states with Medicaid coverage of methadone maintenance, states with block grant funding only, and states without public coverage of methadone. Person-level treatment admission data, which included information on reason for treatment and use of OAT from 36 states were linked to state-level Medicaid policies collected in a 50-state survey. Probabilities of OAT use among Medicaid enrollees in opioid addiction treatment were calculated, with adjustment for demographic characteristics and patterns of substance use. In adjusted analysis, 45.0% of Medicaid-enrolled individuals in opioid addiction treatment in states with Medicaid coverage for methadone maintenance used OAT, compared with 30.1% in states with block grant coverage only and 17.0% in states with no coverage. Differences were widest in nonintensive outpatient settings. Medicaid methadone maintenance coverage is critical for encouraging OAT among individuals with opioid use disorders.

78 FR 32991 - Medicaid Program; Increased Federal Medical Assistance Percentage Changes Under the Affordable...

Science.gov (United States)

2013-06-03

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Part 433 [CMS-2327-CN] RIN 0938-AR38 Medicaid Program; Increased Federal Medical Assistance Percentage Changes Under the Affordable Care Act of 2010; Correction AGENCY: Centers for Medicare & Medicaid Services (CMS...

STAMPS: development and verification of swallowing kinematic analysis software.

Science.gov (United States)

Lee, Woo Hyung; Chun, Changmook; Seo, Han Gil; Lee, Seung Hak; Oh, Byung-Mo

2017-10-17

Swallowing impairment is a common complication in various geriatric and neurodegenerative diseases. Swallowing kinematic analysis is essential to quantitatively evaluate the swallowing motion of the oropharyngeal structures. This study aims to develop a novel swallowing kinematic analysis software, called spatio-temporal analyzer for motion and physiologic study (STAMPS), and verify its validity and reliability. STAMPS was developed in MATLAB, which is one of the most popular platforms for biomedical analysis. This software was constructed to acquire, process, and analyze the data of swallowing motion. The target of swallowing structures includes bony structures (hyoid bone, mandible, maxilla, and cervical vertebral bodies), cartilages (epiglottis and arytenoid), soft tissues (larynx and upper esophageal sphincter), and food bolus. Numerous functions are available for the spatiotemporal parameters of the swallowing structures. Testing for validity and reliability was performed in 10 dysphagia patients with diverse etiologies and using the instrumental swallowing model which was designed to mimic the motion of the hyoid bone and the epiglottis. The intra- and inter-rater reliability tests showed excellent agreement for displacement and moderate to excellent agreement for velocity. The Pearson correlation coefficients between the measured and instrumental reference values were nearly 1.00 (P software is expected to be useful for researchers who are interested in the swallowing motion analysis.

Boron nitride stamp for ultra-violet nanoimprinting lithography fabricated by focused ion beam lithography

International Nuclear Information System (INIS)

Altun, Ali Ozhan; Jeong, Jun-Ho; Rha, Jong-Joo; Kim, Ki-Don; Lee, Eung-Sug

2007-01-01

Cubic boron nitride (c-BN) is one of the hardest known materials (second after diamond). It has a high level of chemical resistance and high UV transmittance. In this study, a stamp for ultra-violet nanoimprint lithography (UV-NIL) was fabricated using a bi-layered BN film deposited on a quartz substrate. Deposition of the BN was done using RF magnetron sputtering. A hexagonal boron nitride (h-BN) layer was deposited for 30 min before c-BN was deposited for 30 min. The thickness of the film was measured as 160 nm. The phase of the c-BN layer was investigated using Fourier transform infrared (FTIR) spectrometry, and it was found that the c-BN layer has a 40% cubic phase. The deposited film was patterned using focused ion beam (FIB) lithography for use as a UV-NIL stamp. Line patterns were fabricated with the line width and line distance set at 150 and 150 nm, respectively. The patterning process was performed by applying different currents to observe the effect of the current value on the pattern profile. The fabricated patterns were investigated using AFM, and it was found that the pattern fabricated by applying a current value of 50 picoamperes (pA) has a better profile with a 65 nm line depth. The UV transmittance of the 160 nm thick film was measured to be 70-86%. The hardness and modulus of the BN was measured to be 12 and 150 GPa, respectively. The water contact angle of the stamp surface was measured at 75 0 . The stamp was applied to UV-NIL without coating with an anti-adhesion layer. Successful imprinting was proved via scanning electron microscope (SEM) images of the imprinted resin

Reimbursement rates and policies for primary molar pit-and-fissure sealants across state Medicaid programs.

Science.gov (United States)

Chi, Donald L; Singh, Jennifer

2013-11-01

Little is known about Medicaid policies regarding reimbursement for placement of sealants on primary molars. The authors identified Medicaid programs that reimbursed dentists for placing primary molar sealants and hypothesized that these programs had higher reimbursement rates than did state programs that did not reimburse for primary molar sealants. The authors obtained Medicaid reimbursement data from online fee schedules and determined whether each state Medicaid program reimbursed for primary molar sealants (no or yes). The outcome measure was the reimbursement rate for permanent tooth sealants (calculated in 2012 U.S. dollars). The authors compared mean reimbursement rates by using the t test (α = .05). Seventeen Medicaid programs reimbursed dentists for placing primary molar sealants (34 percent), and the mean reimbursement rate was $27.57 (range, $16.00 [Maine] to $49.68 [Alaska]). All 50 programs reimbursed dentists for placement of sealants on permanent teeth. The mean reimbursement for permanent tooth sealants was significantly higher in programs that reimbursed for primary molar sealants than in programs that did not ($28.51 and $23.67, respectively; P = .03). Most state Medicaid programs do not reimburse dentists for placing sealants on primary molars, but programs that do so have significantly higher reimbursement rates. Medicaid reimbursement rates are related to dentists' participation in Medicaid and children's dental care use. Reimbursement for placement of sealants on primary molars is a proxy for Medicaid program generosity.

Market environment and Medicaid acceptance: What influences the access gap?

Science.gov (United States)

Bond, Amelia; Pajerowski, William; Polsky, Daniel; Richards, Michael R

2017-12-01

The U.S. health care system is undergoing significant changes. Two prominent shifts include millions added to Medicaid and greater integration and consolidation among firms. We empirically assess if these two industry trends may have implications for each other. Using experimentally derived ("secret shopper") data on primary care physicians' real-world behavior, we observe their willingness to accept new privately insured and Medicaid patients across 10 states. We combine this measure of patient acceptance with detailed information on physician and commercial insurer market structure and show that insurer and provider concentration are each positively associated with relative improvements in appointment availability for Medicaid patients. The former is consistent with a smaller price discrepancy between commercial and Medicaid patients and suggests a beneficial spillover from greater insurer market power. The findings for physician concentration do not align with a simple price bargaining explanation but do appear driven by physician firms that are not vertically integrated with a health system. These same firms also tend to rely more on nonphysician clinical staff. Copyright © 2017 John Wiley & Sons, Ltd.

78 FR 42159 - Medicaid and Children's Health Insurance Programs: Essential Health Benefits in Alternative...

Science.gov (United States)

2013-07-15

... and 156 Medicaid and Children's Health Insurance Programs: Essential Health Benefits in Alternative... Secretary 45 CFR Parts 155 and 156 [CMS-2334-F] RIN 0938-AR04 Medicaid and Children's Health Insurance... Medicaid and the Children's Health Insurance Program (CHIP) eligibility notices, delegation of appeals, and...

Medicare-Medicaid Ever-enrolled Trends Report

Data.gov (United States)

U.S. Department of Health & Human Services — This detailed Excel document accompanies the PDF report on national trends in Medicare-Medicaid dual enrollment from 2006 through the year prior to the current year....

Determination of Unit Pressure Force in Material Volume in the Course of Refractory Stamping Press Moulding

Directory of Open Access Journals (Sweden)

Orłowicz A.W.

2016-06-01

Full Text Available The paper presents results of assessment of the unit pressure force within the refractory material volume in the course press-moulding of stampings for refractory precast shapes. The force was evaluated with the use of physical simulation of deformation undergone by lead balls placed in the raw refractory mass subjected to pressing in a metal die. To determine the value of unit pressure force applied to the aggregate grains in the course of stamping press-moulding, physical model of deformation of a sphere induced by the uniaxial stress state was used.

Trends in Medicaid Reimbursements for Insulin From 1991 Through 2014.

Science.gov (United States)

Luo, Jing; Avorn, Jerry; Kesselheim, Aaron S

2015-10-01

Insulin is a vital medicine for patients with diabetes mellitus. Newer, more expensive insulin products and the lack of generic insulins in the United States have increased costs for patients and insurers. To examine Medicaid payment trends for insulin products. Cost information is available for all 50 states and has been recorded since the 1990s. A time-series analysis comparing reimbursements and prices. Using state- and national-level Medicaid data from 1991 to 2014, we identified all patients who used 1 or more of the 16 insulin products that were continuously available in the United States between 2006 and 2014. Insulin products were classified into rapid-acting and long-acting analogs, short-acting, intermediate, and premixed insulins based on American Diabetes Association Guidelines. Inflation-adjusted payments made to pharmacies by Medicaid per 1 mL (100 IU) of insulin in 2014 US dollars. Since 1991, Medicaid reimbursement per unit (1 mL) of insulin dispensed has risen steadily. In the 1990s, Medicaid reimbursed pharmacies between $2.36 and $4.43 per unit. By 2014, reimbursement for short-acting insulins increased to $9.64 per unit; intermediate, $9.22; premixed, $14.79; and long-acting, $19.78. Medicaid reimbursement for rapid-acting insulin analogs rose to $19.81 per unit. The rate of increase in reimbursement was higher for insulins with patent protection ($0.20 per quarter) than without ($0.05 per quarter) (Preimbursements peaked at $407.4 million dollars in quarter 2 of 2014. Total volume peaked at 29.9 million units in quarter 4 of 2005 and was 21.2 million units in quarter 2 of 2014. Between 1991 and 2014, there was a near-exponential upward trend in Medicaid payments on a per-unit basis for a wide variety of insulin products regardless of formulation, duration of action, and whether the product was patented. Although reimbursements for newer, patent-protected insulin analogs increased at a faster rate than reimbursements for older insulins, payments

Silicon oxide nanoimprint stamp fabrication by edge lithography reinforced with silicon nitride

NARCIS (Netherlands)

Zhao, Yiping; Berenschot, Johan W.; de Boer, Meint J.; Jansen, Henricus V.; Tas, Niels Roelof; Huskens, Jurriaan; Elwenspoek, Michael Curt

2007-01-01

The fabrication of silicon oxide nanoimprint stamp employing edge lithography in combination with silicon nitride deposition is presented. The fabrication process is based on conventional photolithography an weg etching methods. Nanoridges with width dimension of sub-20 nm were fabricated by edge

Comparison of Orthodontic Medicaid Funding in the United States 2006 to 2015

Directory of Open Access Journals (Sweden)

Gerald Minick

2017-08-01

Full Text Available IntroductionOrthodontic treatment is reimbursed by Medicaid based on orthodontic and financial need with qualifiers determined by individual states. Changes in Medicaid-funded orthodontic treatment following the “Great Recession” in 2007 and the enactment of the Affordable Care Act in 2010 were compared for the 50 United States and the District of Columbia to better understand disparities in access to care. The results from this 2015 survey were compared to data gathered in 2006 (1.Materials and methodsMedicaid officials were contacted by email, telephone, or postal mail regarding the age limit for treatment, practitioner type who can determine eligibility and provide treatment, records required for case review, and rate and frequency of reimbursement. When not attained by direct contact, the information was gleaned from online websites, provider manuals, and state orthodontists.ResultsInformation gathered from 50 states and the District of Columbia documents that Medicaid program characteristics and expenditures continue to vary by state. Expenditures and reimbursement rates have decreased since 2006 and vary widely by geographic region. Some states have tightened restrictions on qualifiers and increased submission requirements by providers.ConclusionThe variation and lack of uniformity that still exists among Medicaid orthodontic programs in different states creates disparities in orthodontic care for US citizens. Barriers to care for Medicaid-funded orthodontic treatment have increased since 2006.

Executive federalism and Medicaid demonstration waivers: implications for policy and democratic process.

Science.gov (United States)

Thompson, Frank J; Burke, Courtney

2007-12-01

Executive federalism emphasizes collaboration between the executive branches at the national and state levels to transform grant programs through the implementation process. In this regard, Medicaid demonstration waivers loomed large during the presidencies of Bill Clinton and George W. Bush. This article documents and compares the volume and substance of section 1115 Medicaid waiver activity under the two presidencies. From the perspective of policy performance, Medicaid demonstration waivers provide modest support for the view that states serve as laboratories for policy learning in the health care arena. More broadly, the waivers have not yielded a major solution to the problem of the uninsured and are unlikely to do so. At the same time, they have not (as some have suggested) been a subterranean force for the erosion of Medicaid. To the contrary, these waivers have often enhanced health services for low-income people; above all, they have helped preserve Medicaid as an entitlement by undercutting support for those seeking to convert the program into a block grant. From the perspective of the democratic process, we find that Congress has been a more significant player in shaping waivers than the executive federalism model suggests. While the decision processes surrounding Medicaid waivers often fall short of democratic standards with respect to transparency and opportunities for public input, they still compare favorably to certain alternatives.

Cost-benefit analysis of providing a special subsistence allowance to military personnel who qualify for food stamps

OpenAIRE

Becker, Curtis A., Jr.

2000-01-01

Approved for public release, distribution is unlimited Recent reports cite that military Food Stamp Program beneficiaries may range from 6,400 to 20,000. The need for food stamps has been attributed to several factors, one of which is the perceived military "pay gap". Although, significant strides have been made in recent years to improve quality of life for our service men and women and their families, the military pay system tends to lag behind the civilian employment cost growth index. ...

Can Bundled Payments Be Successful in the Medicaid Population for Primary Joint Arthroplasty?

Science.gov (United States)

Courtney, P Maxwell; Edmiston, Tori; Batko, Brian; Levine, Brett R

2017-11-01

Although some bundled payment models have had success in total joint arthroplasty, concerns exist about access to care for higher cost patients who use more resources. The purpose of this study is to determine whether Medicaid patients have increased hospital costs and more resource utilization in a 90-day episode of care than Medicare or privately insured patients. We retrospectively reviewed a consecutive series of 7268 primary hip and knee arthroplasty patients at a single institution. Using a propensity score-matching algorithm for demographic variables, we matched the 92 consecutive Medicaid patients with 184 privately insured and 184 Medicare patients. Hospital-specific costs, discharge disposition, complications, and 90-day readmissions were analyzed. Medicaid patients had higher mean inpatient hospital costs than both of the matched Medicare and privately insured groups ($15,396 vs $12,165 vs $13,864, P Medicaid and Medicare patients were more likely to be discharged to a rehabilitation facility than privately insured patients (17% vs 21% vs 1%, P Medicaid insurance was a significant independent risk factor for increased hospital costs (odds ratio 3.64, 95% confidence interval 1.80-7.38, P Medicaid patients because of concerns about patient selection and access to care. Further study is needed to determine whether bundling Medicaid arthroplasty costs in a stand-alone program with a separate target price will result in improved outcomes and decreased costs. Copyright © 2017 Elsevier Inc. All rights reserved.

Fabrication of a metallic roll stamp with low internal stress and high hardness for large area display applications by a pulse reverse current electroforming process

International Nuclear Information System (INIS)

Kim, Joongeok; Han, Jungjin; Kim, Taekyung; Kang, Shinill

2014-01-01

With the increasing demand for large scale micro/nano components in the fields of display, energy and electrical devices, etc, the establishment of a roll imprinting process has become a priority. The fabrication of a roll stamp with high dimensional accuracy and uniformity is one of the key issues in the roll imprinting process, because the roll stamp determines the properties of the replicated micro/nano structures. In this study, a method to fabricate a metallic roll stamp with low internal stress, high flatness, and high hardness was proposed by a pulse reverse current (PRC) electroforming process. The effects of PRC electroforming processes on the internal stress, hardness, and grain size of the electroformed stamp were examined, and the optimum process conditions were suggested. As a practical example of the proposed method, various micro-patterns for electronic circuits were fabricated via the roll imprinting process using a PRC electroformed stamp. (paper)

How Medicaid Expansion Affected Out-of-Pocket Health Care Spending for Low-Income Families.

Science.gov (United States)

Glied, Sherry; Chakraborty, Ougni; Russo, Therese

2017-08-01

ISSUE. Prior research shows that low-income residents of states that expanded Medicaid under the Affordable Care Act are less likely to experience financial barriers to health care access, but the impact on out-of-pocket spending has not yet been measured. GOAL. Assess how the Medicaid expansion affected out-of-pocket health care spending for low-income families compared to those in states that did not expand and consider whether effects differed in states that expanded under conventional Medicaid rules vs. waiver programs. METHODS. Analysis of the Consumer Expenditure Survey 2010–2015. KEY FINDINGS AND CONCLUSIONS. Compared to families in nonexpansion states, low-income families in states that did expand Medicaid saved an average of $382 in annual spending on health care. In these states, low-income families were less like to report any out-of-pocket spending on insurance premiums or medical care than were similar families in nonexpansion states. For families that did have some out-of-pocket spending, spending levels were lower in states that expanded Medicaid. Low-income families in Medicaid expansion states were also much less likely to have catastrophically high spending levels. The form of coverage expansion — conventional Medicaid or waiver rules — did not have a statistically significant effect on these outcomes.

Utilization of smoking cessation medication benefits among medicaid fee-for-service enrollees 1999-2008.

Directory of Open Access Journals (Sweden)

Jennifer Kahende

Full Text Available To assess state coverage and utilization of Medicaid smoking cessation medication benefits among fee-for-service enrollees who smoked cigarettes.We used the linked National Health Interview Survey (survey years 1995, 1997-2005 and the Medicaid Analytic eXtract files (1999-2008 to assess utilization of smoking cessation medication benefits among 5,982 cigarette smokers aged 18-64 years enrolled in Medicaid fee-for-service whose state Medicaid insurance covered at least one cessation medication. We excluded visits during pregnancy, and those covered by managed care or under dual enrollment (Medicaid and Medicare. Multivariate logistic regression was used to determine correlates of cessation medication benefit utilization among Medicaid fee-for-service enrollees, including measures of drug coverage (comprehensive cessation medication coverage, number of medications in state benefit, varenicline coverage, individual-level demographics at NHIS interview, age at Medicaid enrollment, and state-level cigarette excise taxes, statewide smoke-free laws, and per-capita tobacco control funding.In 1999, the percent of smokers with ≥1 medication claims was 5.7% in the 30 states that covered at least one Food and Drug Administration (FDA-approved cessation medication; this increased to 9.9% in 2008 in the 44 states that covered at least one FDA-approved medication (p<0.01. Cessation medication utilization was greater among older individuals (≥ 25 years, females, non-Hispanic whites, and those with higher educational attainment. Comprehensive coverage, the number of smoking cessation medications covered and varenicline coverage were all positively associated with utilization; cigarette excise tax and per-capita tobacco control funding were also positively associated with utilization.Utilization of medication benefits among fee-for-service Medicaid enrollees increased from 1999-2008 and varied by individual and state-level characteristics. Given that the

A burial with a stamp seal depicting a Bes-like figure from Abusir

Czech Academy of Sciences Publication Activity Database

Dulíková, V.; Odler, M.; Březinová, Helena; Havelková, P.

2015-01-01

Roč. 2015, č. 15 (2015), s. 69-75 ISSN 1214-3189 Institutional support: RVO:67985912 Keywords : Abusir * Old Kingdom * First Intermediate Period * stamp seal * amulet * Bes * reed coffin * entheses Subject RIV: AC - Archeology, Anthropology, Ethnology

75 FR 5599 - Medicare and Medicaid Programs; Announcement of Applications From Hospitals Requesting Waiver for...

Science.gov (United States)

2010-02-03

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-1341-NC] Medicare and Medicaid Programs; Announcement of Applications From Hospitals Requesting Waiver for Organ Procurement Service Area AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice with...

The Medicaid Rebate: Changes in Oncology Drug Prices After the Affordable Care Act.

Science.gov (United States)

Bonakdar Tehrani, Ali; Carroll, Norman V

2017-08-01

Prescription drug spending is a significant component of Medicaid total expenditures. The Affordable Care Act (ACA) includes a provision that increases the Medicaid rebate for both brand-name and generic drugs. This study examines the extent to which oncology drug prices changed after the increase in the Medicaid rebate in 2010. A pre-post study design was used to evaluate the correlation between the Medicaid rebate increase and oncology drug prices after 2010 using 2006-2013 State Drug Utilization Data. The results show that the average annual price of top-selling cancer drugs in 2006, adjusted for inflation and secular changes in drug prices, have increased by US$154 and US$235 for branded and competitive brand drugs, respectively, following the 2010 ACA; however, generic oncology drug prices showed no significant changes. The findings from this study indicate that oncology drug prices have increased after the 2010 ACA, and suggest that pharmaceutical companies may have increased their drug prices to offset increases in Medicaid rebates.

Receipt of Preventive Services After Oregon's Randomized Medicaid Experiment.

Science.gov (United States)

Marino, Miguel; Bailey, Steffani R; Gold, Rachel; Hoopes, Megan J; O'Malley, Jean P; Huguet, Nathalie; Heintzman, John; Gallia, Charles; McConnell, K John; DeVoe, Jennifer E

2016-02-01

It is predicted that gaining health insurance via the Affordable Care Act will result in increased rates of preventive health services receipt in the U.S., primarily based on self-reported findings from previous health insurance expansion studies. This study examined the long-term (36-month) impact of Oregon's 2008 randomized Medicaid expansion ("Oregon Experiment") on receipt of 12 preventive care services in community health centers using electronic health record data. Demographic data from adult (aged 19-64 years) Oregon Experiment participants were probabilistically matched to electronic health record data from 49 Oregon community health centers within the OCHIN community health information network (N=10,643). Intent-to-treat analyses compared receipt of preventive services over a 36-month (2008-2011) period among those randomly assigned to apply for Medicaid versus not assigned, and instrumental variable analyses estimated the effect of actually gaining Medicaid coverage on preventive services receipt (data collected in 2012-2014; analysis performed in 2014-2015). Intent-to-treat analyses revealed statistically significant differences between patients randomly assigned to apply for Medicaid (versus not assigned) for 8 of 12 assessed preventive services. In intent-to-treat analyses, Medicaid coverage significantly increased the odds of receipt of most preventive services (ORs ranging from 1.04 [95% CI=1.02, 1.06] for smoking assessment to 1.27 [95% CI=1.02, 1.57] for mammography). Rates of preventive services receipt will likely increase as community health center patients gain insurance through Affordable Care Act expansions. Continued effort is needed to increase health insurance coverage in an effort to decrease health disparities in vulnerable populations. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

The Breast and Cervical Cancer Early Detection Program, Medicaid, and breast cancer outcomes among Ohio's underserved women.

Science.gov (United States)

Koroukian, Siran M; Bakaki, Paul M; Htoo, Phyo Than; Han, Xiaozhen; Schluchter, Mark; Owusu, Cynthia; Cooper, Gregory S; Rose, Johnie; Flocke, Susan A

2017-08-15

As an organized screening program, the national Breast and Cervical Cancer Early Detection Program (BCCEDP) was launched in the early 1990s to improve breast cancer outcomes among underserved women. To analyze the impact of the BCCEDP on breast cancer outcomes in Ohio, this study compared cancer stages and mortality across BCCEDP participants, Medicaid beneficiaries, and "all others." This study linked data across the Ohio Cancer Incidence Surveillance System, Medicaid, the BCCEDP database, death certificates, and the US Census and identified 26,426 women aged 40 to 64 years who had been diagnosed with incident invasive breast cancer during the years 2002-2008 (deaths through 2010). The study groups were as follows: BCCEDP participants (1-time or repeat users), Medicaid beneficiaries (women enrolled in Medicaid before their cancer diagnosis [Medicaid/prediagnosis] or around the time of their cancer diagnosis [Medicaid/peridiagnosis]), and all others (women identified as neither BCCEDP participants nor Medicaid beneficiaries). The outcomes included advanced-stage cancer at diagnosis and mortality. A multivariable logistic and survival analysis was conducted to examine the independent association between the BCCEDP and Medicaid status and the outcomes. The percentage of women presenting with advanced-stage disease was highest among women in the Medicaid/peridiagnosis group (63.4%) and lowest among BCCEDP repeat users (38.6%). With adjustments for potential confounders and even in comparison with Medicaid/prediagnosis beneficiaries, those in the Medicaid/peridiagnosis group were twice as likely to be diagnosed with advanced-stage disease (adjusted odds ratio, 2.20; 95% confidence interval, 1.83-2.66). Medicaid/peridiagnosis women are at particularly high risk to be diagnosed with advanced-stage disease. Efforts to reduce breast cancer disparities must target this group of women before they present to Medicaid. Cancer 2017;123:3097-106. © 2017 American Cancer Society

Medicaid expansion and access to care among cancer survivors: a baseline overview.

Science.gov (United States)

Tarazi, Wafa W; Bradley, Cathy J; Harless, David W; Bear, Harry D; Sabik, Lindsay M

2016-06-01

Medicaid expansion under the Affordable Care Act facilitates access to care among vulnerable populations, but 21 states have not yet expanded the program. Medicaid expansions may provide increased access to care for cancer survivors, a growing population with chronic conditions. We compare access to health care services among cancer survivors living in non-expansion states to those living in expansion states, prior to Medicaid expansion under the Affordable Care Act. We use the 2012 and 2013 Behavioral Risk Factor Surveillance System to estimate multiple logistic regression models to compare inability to see a doctor because of cost, having a personal doctor, and receiving an annual checkup in the past year between cancer survivors who lived in non-expansion states and survivors who lived in expansion states. Cancer survivors in non-expansion states had statistically significantly lower odds of having a personal doctor (adjusted odds ratio [AOR] 0.76, 95 % confidence interval [CI] 0.63-0.92, p Medicaid could potentially leave many cancer survivors with limited access to routine care. Existing disparities in access to care are likely to widen between cancer survivors in Medicaid non-expansion and expansion states.

Breast and Cervical Cancer Screening Among Medicaid Beneficiaries: The Role of Physician Payment and Managed Care.

Science.gov (United States)

Sabik, Lindsay M; Dahman, Bassam; Vichare, Anushree; Bradley, Cathy J

2018-05-01

Medicaid-insured women have low rates of cancer screening. There are multiple policy levers that may influence access to preventive services such as screening, including physician payment and managed care. We examine the relationship between each of these factors and breast and cervical cancer screening among nonelderly nondisabled adult Medicaid enrollees. We combine individual-level data on Medicaid enrollment, demographics, and use of screening services from the Medicaid Analytic eXtract files with data on states' Medicaid-to-Medicare fee ratios and estimate their impact on screening services. Higher physician fees are associated with greater screening for comprehensive managed care enrollees; for enrollees in fee-for-service Medicaid, the findings are mixed. Patient participation in primary care case management is a significant moderator of the relationship between physician fees and the rate of screening, as interactions between enrollee primary care case management status and the Medicaid fee ratio are consistently positive across models of screening.

Over, under, or about right: misperceptions of body weight among food stamp participants.

Science.gov (United States)

Ver Ploeg, Michele L; Chang, Hung-Hao; Lin, Biing-Hwan

2008-09-01

The purpose of this research was to investigate the associations between misperception of body weight and sociodemographic factors such as food stamp participation status, income, education, and race/ethnicity. National Health and Nutrition Examination Survey (NHANES) data from 1999-2004 and multivariate logistic regression are used to estimate how sociodemographic factors are associated with (i) the probability that overweight adults misperceive themselves as healthy weight; (ii) the probability that healthy-weight adults misperceive themselves as underweight; and (iii) the probability that healthy-weight adults misperceive themselves as overweight. NHANES data are representative of the US civilian noninstitutionalized population. The analysis included 4,362 men and 4,057 women. BMI derived from measured weight and height was used to classify individuals as healthy weight or overweight. These classifications were compared with self-reported categorical weight status. We find that differences across sociodemographic characteristics in the propensity to underestimate or overestimate weight status were more pronounced for women than for men. Overweight female food stamp participants were more likely to underestimate weight status than income-eligible nonparticipants. Among healthy-weight and overweight women, non-Hispanic black and Mexican-American women, and women with less education were more likely to underestimate actual weight status. We found few differences across sociodemographic characteristics for men. Misperceptions of weight are common among both overweight and healthy-weight individuals and vary across socioeconomic and demographic groups. The nutrition education component of the Food Stamp Program could increase awareness of healthy body weight among participants.

77 FR 23193 - Medicare and Medicaid Programs; Electronic Health Record Incentive Program-Stage 2; Corrections

Science.gov (United States)

2012-04-18

..., 413, and 495 [CMS-0044-CN] RIN 0938-AQ84 Medicare and Medicaid Programs; Electronic Health Record... proposed rule entitled ``Medicare and Medicaid Programs; Electronic Health Record Incentive Program--Stage... (77 FR 13698), the proposed rule entitled ``Medicare and Medicaid Programs; Electronic Health Record...

Stakeholder assessment of comparative effectiveness research needs for Medicaid populations

Science.gov (United States)

Fischer, Michael A; Allen-Coleman, Cora; Farrell, Stephen F; Schneeweiss, Sebastian

2015-01-01

Patients, providers and policy-makers rely heavily on comparative effectiveness research (CER) when making complex, real-world medical decisions. In particular, Medicaid providers and policy-makers face unique challenges in decision-making because their program cares for traditionally underserved populations, especially children, pregnant women and people with mental illness. Because these patient populations have generally been underrepresented in research discussions, CER questions for these groups may be understudied. To address this problem, the Agency for Healthcare Research and Quality commissioned our team to work with Medicaid Medical Directors and other stakeholders to identify relevant CER questions. Through an iterative process of topic identification and refinement, we developed relevant, feasible and actionable questions based on issues affecting Medicaid programs nationwide. We describe challenges and limitations and provide recommendations for future stakeholder engagement. PMID:26388438

Using stamping punch force variation for the identification of changes in lubrication and wear mechanism

Science.gov (United States)

Voss, B. M.; Pereira, M. P.; Rolfe, B. F.; Doolan, M. C.

2017-09-01

The growth in use of Advanced High Strength Steels in the automotive industry for light-weighting and safety has increased the rates of tool wear in sheet metal stamping. This is an issue that adds significant costs to production in terms of manual inspection and part refinishing. To reduce these costs, a tool condition monitoring system is required and a firm understanding of process signal variation must form the foundation for any such monitoring system. Punch force is a stamping process signal that is widely collected by industrial presses and has been linked closely to part quality and tool condition, making it an ideal candidate as a tool condition monitoring signal. In this preliminary investigation, the variation of punch force due to different lubrication conditions and progressive wear are examined. Linking specific punch force signature changes to developing lubrication and wear events is valuable for die wear and stamping condition monitoring. A series of semi-industrial channel forming trials were conducted under different lubrication regimes and progressive die wear. Punch force signatures were captured for each part and Principal Component Analysis (PCA) was applied to determine the key Principal Components of the signature data sets. These Principal Components were linked to the evolution of friction conditions over the course of the stroke for the different lubrication regimes and mechanism of galling wear. As a result, variation in punch force signatures were correlated to the current mechanism of wear dominant on the formed part; either abrasion or adhesion, and to changes in lubrication mechanism. The outcomes of this study provide important insights into punch force signature variation, that will provide a foundation for future work into the development of die wear and lubrication monitoring systems for sheet metal stamping.

National Profile of Medicare-Medicaid dual Beneficiaries

Data.gov (United States)

U.S. Department of Health & Human Services — This provides key statistics on Medicare-Medicaid dual enrollees enrollment, service utilization, expenditures, and chronic conditions for 2012. 2012 is the most...

Long-term acute care hospitals and Georgia Medicaid: Utilization, outcomes, and cost

Directory of Open Access Journals (Sweden)

Evan S. Cole

2016-09-01

Full Text Available Objectives: Because most research on long-term acute care hospitals has focused on Medicare, the objective of this research is to describe the Georgia Medicaid population who received care at a long-term acute care hospital, the type and volume of services provided by these long-term acute care hospitals, and the costs and outcomes of these services. For those with select respiratory conditions, we descriptively compare costs and outcomes to those of patients who received care for the same services in acute care hospitals. Methods: We describe Georgia Medicaid recipients admitted to a long-term acute care hospital between 2011 and 2012. We compare them to a population of Georgia Medicaid recipients admitted to an acute care hospital for one of five respiratory diagnosis-related groups. Measurements used include patient descriptive information, admissions, diagnosis-related groups, length of stay, place of discharge, 90-day episode costs, readmissions, and patient risk scores. Results: We found that long-term acute care hospital admissions for Medicaid patients were fairly low (470 90-day episodes and restricted to complex cases. We also found that the majority of long-term acute care hospital patients were blind or disabled (71.2%. Compared to patients who stayed at an acute care hospital, long-term acute care hospital patients had higher average risk scores (13.1 versus 9.0, lengths of stay (61 versus 38 days, costs (US$143,898 versus US$115,056, but fewer discharges to the community (28.4% versus 51.8%. Conclusion: We found that the Medicaid population seeking care at long-term acute care hospitals is markedly different than the Medicare populations described in other long-term acute care hospital studies. In addition, our study revealed that Medicaid patients receiving select respiratory care at a long-term acute care hospital were distinct from Medicaid patients receiving similar care at an acute care hospital. Our findings suggest that

State Medicaid Expansion Tobacco Cessation Coverage and Number of Adult Smokers Enrolled in Expansion Coverage - United States, 2016.

Science.gov (United States)

DiGiulio, Anne; Haddix, Meredith; Jump, Zach; Babb, Stephen; Schecter, Anna; Williams, Kisha-Ann S; Asman, Kat; Armour, Brian S

2016-12-09

In 2015, 27.8% of adult Medicaid enrollees were current cigarette smokers, compared with 11.1% of adults with private health insurance, placing Medicaid enrollees at increased risk for smoking-related disease and death (1). In addition, smoking-related diseases are a major contributor to Medicaid costs, accounting for about 15% (>$39 billion) of annual Medicaid spending during 2006-2010 (2). Individual, group, and telephone counseling and seven Food and Drug Administration (FDA)-approved medications are effective treatments for helping tobacco users quit (3). Insurance coverage for tobacco cessation treatments is associated with increased quit attempts, use of cessation treatments, and successful smoking cessation (3); this coverage has the potential to reduce Medicaid costs (4). However, barriers such as requiring copayments and prior authorization for treatment can impede access to cessation treatments (3,5). As of July 1, 2016, 32 states (including the District of Columbia) have expanded Medicaid eligibility through the Patient Protection and Affordable Care Act (ACA),* ,† which has increased access to health care services, including cessation treatments (5). CDC used data from the Centers for Medicare and Medicaid Services (CMS) Medicaid Budget and Expenditure System (MBES) and the Behavioral Risk Factor Surveillance System (BRFSS) to estimate the number of adult smokers enrolled in Medicaid expansion coverage. To assess cessation coverage among Medicaid expansion enrollees, the American Lung Association collected data on coverage of, and barriers to accessing, evidence-based cessation treatments. As of December 2015, approximately 2.3 million adult smokers were newly enrolled in Medicaid because of Medicaid expansion. As of July 1, 2016, all 32 states that have expanded Medicaid eligibility under ACA covered some cessation treatments for all Medicaid expansion enrollees, with nine states covering all nine cessation treatments for all Medicaid expansion

78 FR 60824 - Submission for OMB Review; Comment Request

Science.gov (United States)

2013-10-02

... coaching. This system assists in coding interviews for measuring question and interviewer performance and... persons receiving Temporary Assistance for Needy Families (TANF), Food Stamps, Medicare, who are working... Program for Women, Infants, and Children (WIC), and Medicaid. We plan to conduct a rigorous statistical...

Can laboratory and pilot recycling trials predict adhesive removal in commercial recycling systems? : results from the USPS environmentally benign stamp project

Science.gov (United States)

Carl Houtman; Daniel Seiter; Nancy Ross Sutherland; Donald Donermeyer

2002-01-01

The ultimate goal of the US Postal Service (USPS) Environmentally Benign Stamp Program is to develop stamp laminates, i.e., face paper, adhesive and siliconized liner, that do not cause difficulties in recycling mills. The criterion for success, and the USPS definition of benignity, is the avoidance of process and product quality hardships when such PSA laminates are...

The Medicaid Medically Improved Group, Losing Disability...

Data.gov (United States)

U.S. Department of Health & Human Services — According to findings reported in, The Medicaid Medically Improved Group, Losing Disability Status and Growing Earnings, published in Volume 4, Issue 1 of the...

Medicaid. Will the public program neglect the poor to pay for the elderly?

Science.gov (United States)

Hudson, T

1995-05-20

If the policy-makers trying to fix Medicaid think they've thought of every angle, they should think about the situation of Peggy, a middle-class Illinois widow stricken with Alzheimer's disease, who's being forced to spend down her savings to get Medicaid coverage for her nursing home care. In fact, there are several million Peggys out there, and balancing their needs against those of the hard-core Medicaid poor may break a system that was never resource-blessed to begin with.

Medicaid in Ohio: The Politics of Expansion, Reauthorization, and Reform.

Science.gov (United States)

Skinner, Daniel

2015-12-01

When, in 2012, the US Supreme Court held that Medicaid expansion sanctioned by the Affordable Care Act (ACA) was essentially optional for states, it ushered in a newly contentious state politics. States led by Republican governors and legislatures opposed to the ACA had to decide whether to accept extensive federal funding to expand Medicaid for citizens in their states who were earning up to 138 percent of the federal poverty level. This Report from the States focuses on Ohio, whose Republican governor successfully navigated the rancorous politics of Medicaid to expand the state's program in 2014. Working at odds with his own party and gaining praise from traditional political opponents for his leadership on the issue, John Kasich circumvented the state legislature, turning to the Controlling Board to bring about initial expansion. In the wake of Kasich's landslide reelection in 2014, the politics of expansion and reauthorization have given way to a pervasive discourse of "reform." In this next phase Kasich has endorsed policy positions (e.g., cost sharing, a focus on "personal responsibility") that reunite him with his party's more traditional view of Medicaid while continuing to emphasize the importance of expansion. Copyright © 2016 by Duke University Press.

Investigation of the Phase Formation of AlSi-Coatings for Hot Stamping of Boron Alloyed Steel

International Nuclear Information System (INIS)

Veit, R.; Kolleck, R.; Hofmann, H.; Sikora, S.

2011-01-01

Hot stamping of boron alloyed steel is gaining more and more importance for the production of high strength automotive body parts. Within hot stamping of quenchenable steels the blank is heated up to austenitization temperature, transferred to the tool, formed rapidly and quenched in the cooled tool. To avoid scale formation during the heating process of the blank, the sheet metal can be coated with an aluminium-silicum alloy. The meltimg temperature of this coating is below the austenitization temperature of the base material. This means, that a diffusion process between base material and coating has to take place during heating, leading to a higher melting temperature of the coating.In conventional heating devices, like roller hearth furnaces, the diffusion process is reached by relatively low heating rates. New technologies, like induction heating, reach very high heating rates and offer great potentials for the application in hot stamping. Till now it is not proofed, that this technology can be used with aluminum-silicon coated materials. This paper will present the results of comparative heating tests with a conventional furnace and an induction heating device. For different time/temperature-conditions the phase formation within the coating will be described.

Studies on the finite element simulation in sheet metal stamping processes

Science.gov (United States)

Huang, Ying

The sheet metal stamping process plays an important role in modern industry. With the ever-increasing demand for shape complexity, product quality and new materials, the traditional trial and error method for setting up a sheet metal stamping process is no longer efficient. As a result, the Finite Element Modeling (FEM) method has now been widely used. From a physical point of view, the formability and the quality of a product are influenced by several factors. The design of the product in the initial stage and the motion of the press during the production stage are two of these crucial factors. This thesis focuses on the numerical simulation for these two factors using FEM. Currently, there are a number of commercial FEM software systems available in the market. These software systems are based on an incremental FEM process that models the sheet metal stamping process in small incremental steps. Even though the incremental FEM is accurate, it is not suitable for the initial conceptual design for its needing of detailed design parameters and enormous calculation times. As a result, another type of FEM, called the inverse FEM method or one-step FEM method, has been proposed. While it is less accurate than that of the incremental method, this method requires much less computation and hence, has a great potential. However, it also faces a number of unsolved problems, which limits its application. This motivates the presented research. After the review of the basic theory of the inverse method, a new modified arc-length search method is proposed to find better initial solution. The methods to deal with the vertical walls are also discussed and presented. Then, a generalized multi-step inverse FEM method is proposed. It solves two key obstacles: the first one is to determine the initial solution of the intermediate three-dimensional configurations and the other is to control the movement of nodes so they could only slide on constraint surfaces during the search by

77 FR 9931 - Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-October Through December 2011

Science.gov (United States)

2012-02-21

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-9069-N] Medicare and Medicaid Programs; Quarterly Listing of Program Issuances--October Through December 2011 AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice. SUMMARY: This quarterly...

78 FR 45231 - Medicare and Medicaid Programs; Initial Approval of Center for Improvement in Healthcare Quality...

Science.gov (United States)

2013-07-26

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-3280-FN] Medicare and Medicaid Programs; Initial Approval of Center for Improvement in Healthcare Quality's (CIHQ's) Hospital Accreditation Program AGENCY: Centers for Medicare and Medicaid Services, HHS. ACTION: Final...

Medicaid care management: description of high-cost addictions treatment clients.

Science.gov (United States)

Neighbors, Charles J; Sun, Yi; Yerneni, Rajeev; Tesiny, Ed; Burke, Constance; Bardsley, Leland; McDonald, Rebecca; Morgenstern, Jon

2013-09-01

High utilizers of alcohol and other drug treatment (AODTx) services are a priority for healthcare cost control. We examine characteristics of Medicaid-funded AODTx clients, comparing three groups: individuals cost clients in the top decile of AODTx expenditures (HC; n=5,718); and 1760 enrollees in a chronic care management (CM) program for HC clients implemented in 22 counties in New York State. Medicaid and state AODTx registry databases were combined to draw demographic, clinical, social needs and treatment history data. HC clients accounted for 49% of AODTx costs funded by Medicaid. As expected, HC clients had significant social welfare needs, comorbid medical and psychiatric conditions, and use of inpatient services. The CM program was successful in enrolling some high-needs, high-cost clients but faced barriers to reaching the most costly and disengaged individuals. Copyright © 2013 Elsevier Inc. All rights reserved.

Medicaid and the politics of groups: recipients, providers, and policy making.

Science.gov (United States)

Kronebusch, K

1997-06-01

There is a substantial heterogeneity of interests within the Medicaid program. Its major beneficiary groups include the elderly, people with disabilities, children in low-income families, and adults receiving Aid to Families with Dependent Children. Providers who deliver medical services to these recipients represent another set of potential claimants. These groups are likely to be treated differently by the politics that affect the design and management of the Medicaid program. The Medicaid recipient groups vary in several important dimensions: First, the groups differ politically, a dimension that includes their political participation, their relationships to parties and electoral coalitions, the images they present to other political actors, and the legacy of public policies that affect them. Second, the groups have different medical and social needs. Third, the groups differ with respect to economic constraints, including the political economy of labor markets and of government spending programs, and they have differing relationships to the various types of medical providers. The medical providers are themselves political actors with a variety of characteristics that create political advantages relative to recipients, although there is also diversity among providers. The politics of the Medicaid program involves more than simply technical decisions about eligibility, coverage of medical services, reimbursement, and the implementation of managed care initiatives. Instead the differences between the program's multiple claimants are an important element of current Medicaid politics and the likely path of future reforms.

States With Medically Needy Pathways: Differences in Long-Term and Temporary Medicaid Entry for Low-Income Medicare Beneficiaries.

Science.gov (United States)

Keohane, Laura M; Trivedi, Amal; Mor, Vincent

2017-10-01

Medically needy pathways may provide temporary catastrophic coverage for low-income Medicare beneficiaries who do not otherwise qualify for full Medicaid benefits. Between January 2009 and June 2010, states with medically needy pathways had a higher percentage of low-income beneficiaries join Medicaid than states without such programs (7.5% vs. 4.1%, p < .01). However, among new full Medicaid participants, living in a state with a medically needy pathway was associated with a 3.8 percentage point (adjusted 95% confidence interval [1.8, 5.8]) increase in the probability of switching to partial Medicaid and a 4.5 percentage point (adjusted 95% confidence interval [2.9, 6.2]) increase in the probability of exiting Medicaid within 12 months. The predicted risk of leaving Medicaid was greatest when new Medicaid participants used only hospital services, rather than nursing home services, in their first month of Medicaid benefits. Alternative strategies for protecting low-income Medicare beneficiaries' access to care could provide more stable coverage.

The impact of Medicaid-linked reimbursements on revenues of public sexually transmitted disease clinics.

Science.gov (United States)

Downey, Lois; Lafferty, William E; Krekeler, Barbara

2002-02-01

Public sexually transmitted disease (STD) clinics faced with decreased tax revenue and increased costs must evaluate alternative revenue sources. To report one public STD clinic's Medicaid-linked revenue and discuss the association between system characteristics and reimbursement potential. This was a cross-sectional study of 4208 patients visiting the clinic for new problems during a 6-month period. Of 458 Medicaid-enrolled patients, only 55% acknowledged enrollment at the time of visit. The clinic captured revenue for many of the remaining 45% through a centralized public health information/billing system, which submitted retroactive STD clinic claims when patients self-reported Medicaid enrollment at later visits to other public health clinics. These belated self-reports also contributed to Medicaid administrative-match reimbursements. An estimated $100,000 (31% of the clinic's direct reimbursements for service) would have been lost in 2000, had detection of Medicaid enrollment been based exclusively on patients' self-reports at STD clinic visits.

Early Experience of Financial Performance and Solvency of Medicaid-Focused Insurers Under ACA Expansion.

Science.gov (United States)

McCue, Michael J

2017-12-01

To allow for greater coverage of the uninsured, the Affordable Care Act expanded Medicaid coverage in 2014. Accessing financial data of state health insurers from the National Association of Insurance Commissioners, this data trend study compares the financial performance and solvency of Medicaid-focused health insurers prior to and after the first year expansion of Medicaid coverage. After the first year of Medicaid expansion, there was a significant increase in operating profit margin ratio for Medicaid-focused health insurers within expansion states. Lower medical loss ratio as well as no change in administrative costs contributed to this profitable position. The risk-based capital ratio for solvency increased significantly for health insurers in nonexpansion states while there was no change in this ratio for health insurers in expansion states. Conversely, the other important solvency ratio of cash flow margin increased significantly for health insurers in expansion states but not for insurers in nonexpansion states.

78 FR 98 - Medicare and Medicaid Programs; Announcement of Application From a Hospital Requesting Waiver for...

Science.gov (United States)

2013-01-02

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-1456-NC] Medicare and Medicaid Programs; Announcement of Application From a Hospital Requesting Waiver for Organ Procurement Service Area AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice with...

77 FR 51539 - Medicare and Medicaid Programs; Announcement of Application From a Hospital Requesting Waiver for...

Science.gov (United States)

2012-08-24

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-1452-NC] Medicare and Medicaid Programs; Announcement of Application From a Hospital Requesting Waiver for Organ Procurement Service Area AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice with...

78 FR 19269 - Medicare and Medicaid Programs; Announcement of Application From a Hospital Requesting Waiver for...

Science.gov (United States)

2013-03-29

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-1457-NC] Medicare and Medicaid Programs; Announcement of Application From a Hospital Requesting Waiver for Organ Procurement Service Area AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice with...

75 FR 16149 - Medicaid and CHIP Programs; Meeting of the CHIP Working Group-April 26, 2010

Science.gov (United States)

2010-03-31

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-2312-N] DEPARTMENT OF LABOR Employee Benefits Security Administration Medicaid and CHIP Programs; Meeting of the CHIP Working Group-- April 26, 2010 AGENCIES: Centers for Medicare & Medicaid Services (CMS), Department of...

The Cost of Cost-Sharing: The Impact of Medicaid Benefit Design on Influenza Vaccination Uptake

Directory of Open Access Journals (Sweden)

Charles Stoecker

2017-03-01

Full Text Available Prior research indicates that cost-sharing and lack of insurance coverage reduce preventive services use among low-income persons. State Medicaid policy may affect the uptake of recommended adult vaccinations. We examined the impact of three aspects of Medicaid benefit design (coverage for vaccines, prohibiting cost-sharing, and copayment amounts on vaccine uptake in the fee-for-service Medicaid population 19–64 years old. We combined previously published reports to obtain state Medicaid policy information from 2003 and 2012. Data on influenza vaccination uptake were taken from the Behavioral Risk Factor Surveillance System. We used a differences-in-differences framework, controlling for national trends and state differences, to estimate the effect of each benefit design factor on vaccination uptake in different Medicaid-eligible populations. Each additional dollar of copayment for vaccination decreased influenza vaccination coverage 1–6 percentage points. The effects of covering vaccines or prohibiting cost-sharing were mixed. Imposing copayments for vaccination is associated with lower vaccination coverage. These findings have implications for the implementation of Medicaid expansion in states that currently impose copayments.

State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Accessing Treatments - United States, 2015-2017.

Science.gov (United States)

DiGiulio, Anne; Jump, Zach; Yu, Annie; Babb, Stephen; Schecter, Anna; Williams, Kisha-Ann S; Yembra, Debbie; Armour, Brian S

2018-04-06

Cigarette smoking prevalence among Medicaid enrollees (25.3%) is approximately twice that of privately insured Americans (11.8%), placing Medicaid enrollees at increased risk for smoking-related disease and death (1). Medicaid spends approximately $39 billion annually on treating smoking-related diseases (2). Individual, group, and telephone counseling and seven Food and Drug Administration (FDA)-approved medications* are effective in helping tobacco users quit (3). Although state Medicaid coverage of tobacco cessation treatments improved during 2014-2015, coverage was still limited in most states (4). To monitor recent changes in state Medicaid cessation coverage for traditional (i.e., nonexpansion) Medicaid enrollees, the American Lung Association collected data on coverage of a total of nine cessation treatments: individual counseling, group counseling, and seven FDA-approved cessation medications † in state Medicaid programs during July 1, 2015-June 30, 2017. The American Lung Association also collected data on seven barriers to accessing covered treatments, such as copayments and prior authorization. As of June 30, 2017, 10 states covered all nine of these treatments for all enrollees, up from nine states as of June 30, 2015; of these 10 states, Missouri was the only state to have removed all seven barriers to accessing these cessation treatments. State Medicaid programs that cover all evidence-based cessation treatments, remove barriers to accessing these treatments, and promote covered treatments to Medicaid enrollees and health care providers would be expected to reduce smoking, smoking-related disease, and smoking-attributable federal and state health care expenditures (5-7).

42 CFR 495.332 - State Medicaid health information technology (HIT) plan requirements.

Science.gov (United States)

2010-10-01

... and strategic plan for the next 5 years. (2) A description of how the State Medicaid HIT plan will be... processes that enable improved program administration for the Medicaid enterprise; (ii) Includes business... used certified EHR technology during the EHR reporting period, and that they have adopted, implemented...

Payments and Utilization of Immunization Services Among Children Enrolled in Fee-for-Service Medicaid.

Science.gov (United States)

Tsai, Yuping

2018-01-01

To examine the association between state Medicaid vaccine administration fees and children's receipt of immunization services. The study used the 2008-2012 Medicaid Analytic eXtract data and included children aged 0-17 years and continuously enrolled in a Medicaid fee-for-service plan in each study year. Analyses were restricted to 8 states with a Medicaid managed-care penetration rate Medicaid vaccine administration fees, age group, sex, race/ethnicity, state unemployment rate, state managed-care penetration rate, and state and year-fixed effects. A total of 1,678,288 children were included. In 2008-2012, the average proportion of children making ≥1 vaccination visit per year was 31% and the mean number of vaccination visits was 0.9. State Medicaid reimbursements for vaccine administration was positively associated with immunization service utilization; for every $1 increase in the payment amount, the probability of children making ≥1 vaccination visit increased by 0.72 percentage point (95% confidence interval, 0.23-1.21; P=0.01), representing a 2% increase from the mean and the number of vaccination visits increased by 0.03 (95% confidence interval, -0.00 to 0.06; PMedicaid reimbursements for vaccine administration were associated with increased proportion of children receiving immunization services.

Using time-series intervention analysis to understand U.S. Medicaid expenditures on antidepressant agents.

Science.gov (United States)

Ferrand, Yann; Kelton, Christina M L; Guo, Jeff J; Levy, Martin S; Yu, Yan

2011-03-01

Medicaid programs' spending on antidepressants increased from $159 million in 1991 to $2 billion in 2005. The National Institute for Health Care Management attributed this expenditure growth to increases in drug utilization, entry of newer higher-priced antidepressants, and greater prescription drug insurance coverage. Rising enrollment in Medicaid has also contributed to this expenditure growth. This research examines the impact of specific events, including branded-drug and generic entry, a black box warning, direct-to-consumer advertising (DTCA), and new indication approval, on Medicaid spending on antidepressants. Using quarterly expenditure data for 1991-2005 from the national Medicaid pharmacy claims database maintained by the Centers for Medicare and Medicaid Services, a time-series autoregressive integrated moving average (ARIMA) intervention analysis was performed on 6 specific antidepressant drugs and on overall antidepressant spending. Twenty-nine potentially relevant interventions and their dates of occurrence were identified from the literature. Each was tested for an impact on the time series. Forecasts from the models were compared with a holdout sample of actual expenditure data. Interventions with significant impacts on Medicaid expenditures included the patent expiration of Prozac® (P0.05), implying that the expanding market for antidepressants overwhelmed the effect of generic competition. Copyright © 2011 Elsevier Inc. All rights reserved.

Investigation of Hardness Change for Spot Welded Tailored Blank in Hot Stamping Using CCT and Deformation-CCT Diagrams

Science.gov (United States)

Yogo, Yasuhiro; Kurato, Nozomi; Iwata, Noritoshi

2018-04-01

When an outer panel of a B-pillar is manufactured with the hot stamping process, reinforcements are spot welded on its inner side. Before reinforcements are added, the microstructure of the outer panel is martensite. However, reheating during spot welding changes the martensite to ferrite, which has a lower hardness in the heat-affected zone than in other areas. If spot welding is conducted before hot stamping for making a spot welded tailored blank, the microstructure in the spot welded tailored blank after hot stamping is martensite. This sequence of processes avoids hardness reduction due to spot welding. In this study, the hardness and microstructure around spot welded parts of the tailored blank were investigated. The results clearly showed that areas close to the spot welded parts are severely stretched during hot stamping. In addition, stretching suppresses the martensitic phase transformation and reduces the hardness. To characterize this phenomenon, a simulation was conducted that considered the effects of pre-strain on the phase transformation. A continuous cooling transformation (CCT) diagram and a deformation continuous cooling transformation (DCCT) diagram were made in order to quantify the effect of the cooling rate and pre-strain on the phase transformation and hardness. The hardness was then calculated using the experimentally measured CCT and DCCT diagrams and the finite element analysis results. The calculated hardness was compared with the experimental hardness. Good agreement was found between the calculated and experimental results.

Investigation of Hardness Change for Spot Welded Tailored Blank in Hot Stamping Using CCT and Deformation-CCT Diagrams

Science.gov (United States)

Yogo, Yasuhiro; Kurato, Nozomi; Iwata, Noritoshi

2018-06-01

When an outer panel of a B-pillar is manufactured with the hot stamping process, reinforcements are spot welded on its inner side. Before reinforcements are added, the microstructure of the outer panel is martensite. However, reheating during spot welding changes the martensite to ferrite, which has a lower hardness in the heat-affected zone than in other areas. If spot welding is conducted before hot stamping for making a spot welded tailored blank, the microstructure in the spot welded tailored blank after hot stamping is martensite. This sequence of processes avoids hardness reduction due to spot welding. In this study, the hardness and microstructure around spot welded parts of the tailored blank were investigated. The results clearly showed that areas close to the spot welded parts are severely stretched during hot stamping. In addition, stretching suppresses the martensitic phase transformation and reduces the hardness. To characterize this phenomenon, a simulation was conducted that considered the effects of pre-strain on the phase transformation. A continuous cooling transformation (CCT) diagram and a deformation continuous cooling transformation (DCCT) diagram were made in order to quantify the effect of the cooling rate and pre-strain on the phase transformation and hardness. The hardness was then calculated using the experimentally measured CCT and DCCT diagrams and the finite element analysis results. The calculated hardness was compared with the experimental hardness. Good agreement was found between the calculated and experimental results.

Linking Medicare, Medicaid, and Cancer Registry Data...

Data.gov (United States)

U.S. Department of Health & Human Services — Linking Medicare, Medicaid, and Cancer Registry Data to Study the Burden of Cancers in West Virginia In the United States, the elderly carry an unequal burden of...

77 FR 11677 - Medicaid Program; Review and Approval Process for Section 1115 Demonstrations

Science.gov (United States)

2012-02-27

... for Medicare & Medicaid Services 42 CFR Part 431 Department of the Treasury 31 CFR Part 33 Department of Health and Human Services 45 CFR Part 155 Medicaid Program; Review and Approval Process for... Regulations#0;#0; [[Page 11678

7 CFR 226.2 - Definitions.

Science.gov (United States)

2010-01-01

... stamp or FDPIR household or is a current SSI or Medicaid participant. Yogurt means commercially coagulated milk products obtained by the fermentation of specific bacteria, that meet milk fat or milk solid... Drug Administration's Standard of Identity for yogurt, lowfat yogurt, and nonfat yogurt, (21 CFR 131...

Maximizing federal Medicaid dollars: nursing home provider tax adoption, 2000-2004.

Science.gov (United States)

Miller, Edward Alan; Wang, Lili

2009-12-01

Since Medicaid is jointly financed by the federal and state governments, state officials have sought to offset state expenditures by maximizing federal contributions. One such strategy is to adopt a provider tax, which enables states to collect revenues from providers; those revenues are then used to pay for services rendered to Medicaid recipients, thereby leveraging federal matching dollars without concomitant increases in state expenditures. The number of states adopting a nursing home tax increased from thirteen to thirty-one between 2000 and 2004. This study seeks to identify the factors that spurred the rapid increase in nursing home provider taxes following implementation of the Balanced Budget Act of 1997. Results indicate that states with more powerful nursing home lobbies, lower proportions of private pay nursing home residents, worse fiscal health, weaker fiscal capacity, broader Medicaid eligibility, and nursing home supply restrictions were more likely to adopt. This implies that state officials react rationally to prevailing fiscal and programmatic circumstances when formulating policy under Medicaid and that providers seek relief, in part, from the adverse fiscal consequences of federal policy changes by promoting policy change at the state level.

Dental Student, Resident, and Faculty Attitudes Toward Treating Medicaid Patients.

Science.gov (United States)

Behar-Horenstein, Linda S; Feng, Xiaoying

2017-11-01

Failure to receive proper oral health care including both prevention and maintenance is influenced by myriad and complex social, economic, and dental factors, including access to care. Reducing oral health disparities requires changes in the preparation of future dentists as well as measuring and influencing the attitudes and knowledge of practicing dentists. The aim of this study was to determine the likelihood that future dentists (students and residents) and faculty members at one U.S. dental school would treat Medicaid participants. Attitudes were measured using the Deamonte Driver scenario survey, which assesses factors affecting dentists' participation in Medicaid. In October 2012, all 113 full-time faculty members were invited to participate, and 60 completed the survey, for a response rate of 53.1%. In January and February 2013, all 18 residents in the dental clinics and university hospital were invited to participate, and 16 completed the survey, for a response rate of 88.9%. From 2013 to 2015, all 267 students in three classes were invited to participate: first-year students in the Classes of 2017 and 2018 and fourth-year students in the Class of 2015. A total of 255 students completed the survey, for an overall student response rate of 95.5%. The results showed that the students were more likely to participate in caring for Medicaid patients than the faculty and residents. The white and male students had stronger negative stereotypes about Medicaid patients than the females and underrepresented minority students, while residents had stronger negative stereotypes about Medicaid patients than the students and faculty. Overall, the cultural competency skills, beliefs, and attitudes of these faculty members and residents were less developed than those of their students, signaling a need for broad educational and faculty development programs to fully prepare the future dental workforce to care for these patients.

Receipt of Preventive Services After Oregon’s Randomized Medicaid Experiment

Science.gov (United States)

Marino, Miguel; Bailey, Steffani R.; Gold, Rachel; Hoopes, Megan J.; O’Malley, Jean P.; Huguet, Nathalie; Heintzman, John; Gallia, Charles; McConnell, K. John; DeVoe, Jennifer E.

2015-01-01

Introduction It is predicted that gaining health insurance via the Affordable Care Act will result in increased rates of preventive health services receipt in the U.S, primarily based on self-reported findings from previous health insurance expansion studies. This study examined the long-term (36-month) impact of Oregon’s 2008 randomized Medicaid expansion (“Oregon Experiment”) on receipt of 12 preventive care services in community health centers using electronic health record data. Methods Demographic data from adult (aged 19–64 years) Oregon Experiment participants were probabilistically matched to electronic health record data from 49 Oregon community health centers within the OCHIN community health information network (N=10,643). Intent-to-treat analyses compared receipt of preventive services over a 36-month (2008–2011) period among those randomly assigned to apply for Medicaid versus not assigned, and instrumental variable analyses estimated the effect of actually gaining Medicaid coverage on preventive services receipt (data collected in 2012–2014; analysis performed in 2014–2015). Results Intent-to-treat analyses revealed statistically significant differences between patients randomly assigned to apply for Medicaid (versus not assigned) for eight of 12 assessed preventive services. In intent-to-treat[MM1] analyses, Medicaid coverage significantly increased the odds of receipt of most preventive services (ORs ranging from 1.04 [95% CI=1.02, 1.06] for smoking assessment to 1.27 [95% CI=1.02, 1.57] for mammography). Conclusions Rates of preventive services receipt will likely increase as community health center patients gain insurance through Affordable Care Act expansions. Continued effort is needed to increase health insurance coverage in an effort to decrease health disparities in vulnerable populations. PMID:26497264

The Affordable Care Act Medicaid Expansions and Personal Finance.

Science.gov (United States)

Caswell, Kyle J; Waidmann, Timothy A

2017-09-01

Using a novel data set from a major credit bureau, we examine the early effects of the Affordable Care Act Medicaid expansions on personal finance. We analyze less common events such as personal bankruptcy, and more common occurrences such as medical collection balances, and change in credit scores. We estimate triple-difference models that compare individual outcomes across counties that expanded Medicaid versus counties that did not, and across expansion counties that had more uninsured residents versus those with fewer. Results demonstrate financial improvements in states that expanded their Medicaid programs as measured by improved credit scores, reduced balances past due as a percent of total debt, reduced probability of a medical collection balance of $1,000 or more, reduced probability of having one or more recent medical bills go to collections, reduction in the probability of experiencing a new derogatory balance of any type, reduced probability of incurring a new derogatory balance equal to $1,000 or more, and a reduction in the probability of a new bankruptcy filing.

Experimental Investigation About Stamping Behaviour of 3D Warp Interlock Composite Preforms

Science.gov (United States)

Dufour, Clément; Wang, Peng; Boussu, François; Soulat, Damien

2014-10-01

Forming of continuous fibre reinforcements and thermoplastic resin commingled prepregs can be performed at room temperature due to its similar textile structure. The "cool" forming stage is better controlled and more economical. The increase of temperature and the resin consolidation phases after the forming can be carried out under the isothermal condition thanks to a closed system. It can avoid the manufacturing defects easily experienced in the non-isothermal thermoforming, in particular the wrinkling [1]. Glass/Polypropylene commingled yarns have been woven inside different three-dimensional (3D) warp interlock fabrics and then formed using a double-curved shape stamping tool. The present study investigates the in-plane and through-thickness behaviour of the 3D warp interlock fibrous reinforcements during forming with a hemispherical punch. Experimental data allow analysing the forming behaviour in the warp and weft directions and on the influence of warp interlock architectures. The results point out that the layer to layer warp interlock preform has a better stamping behaviour, in particular no forming defects and good homogeneity in thickness.

The comparison of two continuum damage mechanics-based material models for formability prediction of AA6082 under hot stamping conditions

Science.gov (United States)

Shao, Z.; Li, N.; Lin, J.

2017-09-01

The hot stamping and cold die quenching process has experienced tremendous development in order to obtain shapes of structural components with great complexity in automotive applications. Prediction of the formability of a metal sheet is significant for practical applications of forming components in the automotive industry. Since microstructural evolution in an alloy at elevated temperature has a large effect on formability, continuum damage mechanics (CDM)-based material models can be used to characterise the behaviour of metals when a forming process is conducted at elevated temperatures. In this paper, two sets of unified multi-axial constitutive equations based on material’s stress states and strain states, respectively, were calibrated and used to effectively predict the thermo-mechanical response and forming limits of alloys under complex hot stamping conditions. In order to determine and calibrate the two material models, formability tests of AA6082 using a developed novel biaxial testing system were conducted at various temperatures and strain rates under hot stamping conditions. The determined unified constitutive equations from experimental data are presented in this paper. It is found that both of the stress-state based and strain-state based material models can predict the formability of AA6082 under hot stamping conditions.

Prevalence and Geographic Variations of Polypharmacy Among West Virginia Medicaid Beneficiaries.

Science.gov (United States)

Feng, Xue; Tan, Xi; Riley, Brittany; Zheng, Tianyu; Bias, Thomas K; Becker, James B; Sambamoorthi, Usha

2017-11-01

West Virginia (WV) residents are at high risk for polypharmacy given its considerable chronic disease burdens. To evaluate the prevalence, correlates, outcomes, and geographic variations of polypharmacy among WV Medicaid beneficiaries. In this cross-sectional study, we analyzed 2009-2010 WV Medicaid fee-for-service (FFS) claims data for adults aged 18-64 (N=37,570). We defined polypharmacy as simultaneous use of drugs from five or more different drug classes on a daily basis for at least 60 consecutive days in one year. Multilevel logistic regression was used to explore the individual- and county-level factors associated with polypharmacy. Its relationship with healthcare utilization was assessed using negative binomial regression and logistic regression. The univariate local indicators of spatial association method was applied to explore spatial patterns of polypharmacy in WV. The prevalence of polypharmacy among WV Medicaid beneficiaries was 44.6%. High-high clusters of polypharmacy were identified in southern WV, indicating counties with above-average prevalence surrounded by counties with above-average prevalence. Polypharmacy was associated with being older, female, eligible for Medicaid due to cash assistance or medical eligibility, having any chronic conditions or more chronic conditions, and living in a county with lower levels of education. Polypharmacy was associated with more hospitalizations, emergency department visits, and outpatient visits, as well as higher non-drug medical expenditures. Polypharmacy was prevalent among WV Medicaid beneficiaries and was associated with substantial healthcare utilization and expenditures. The clustering of high prevalence of polypharmacy in southern WV may suggest targeted strategies to reduce polypharmacy burden in these areas.

Ben Franklin, America’s Postage Stamp Star — on the Wane?

Directory of Open Access Journals (Sweden)

François Brunet

2010-01-01

Full Text Available This paper is an assessment of Ben Franklin’s evolving figure in U.S. postage stamps, focusing especially on the contrast between the 2006 tercentennial Franklin 4-stamp panel, a rather high-brow representation of Franklin as an intellectual, and his traditional image as a homely, common face. The singular history of U.S. postage stamps, with their innovative choice of historical figures as subject matter and their broader emphasis on commemoration, is briefly summarized. The evolution of the Franklin figure — the most common postal image, along with George Washington — is then detailed, showing how the traditional image prevailed until the 1950s, before being progressively displaced by a more cultural and, lately, intellectual image of the nation’s “electrizer”.Cet article vise à interpréter l’évolution de la figure de Benjamin Franklin dans les timbres-poste des Etats-Unis, en se fondant notamment sur le contraste entre le bloc de quatre timbres émis lors du tricentenaire en 2006, qui représente Franklin dans les différents métiers d’un intellectuel des Lumières, et son image traditionnelle d’Américain simple et moyen. On retrace tout d’abord l’histoire singulière des timbres américains, caractérisée par le choix innovant de figures historiques comme sujets et plus généralement par la prééminence de la fonction commémorative. Puis on étudie en détail l’évolution de la figure de Franklin — sujet le plus fréquent des timbres américains avec George Washington — en montrant que l’image traditionnelle s’est perpétuée jusqu’aux années 1950, avant de céder progressivement à une image plus culturelle et, récemment, plus intellectuelle.

Influence of temperature and friction on the 22MnB5 formability under hot stamping conditions

Science.gov (United States)

Venturato, G.; Ghiotti, A.; Bruschi, S.

2018-05-01

The need to increase the safety and decrease the weight of the car body-in-white has determined the success of the direct hot stamping process as a primary technology for the automotive sector. Thanks to this process, parts with high strength-to-weight ratio can be obtained along with high stiffness and increase of the crashworthiness properties. Moreover, the thinner metal sheets used to manufacture the pieces lead to a decrease of the total weight of the car body-in-white, with a consequent reduction of the CO2 emissions. The direct hot stamping process is becoming the key to obtain pieces with high mechanical properties, thanks to the quenching stage that allows the manufacture of complex shapes characterized by a fully martensitic structure, thanks to the forming stage at elevated temperature and subsequent hardening inside the cooled dies. The aim of this paper is the investigation of the influence that the forming temperature may have on the formability of 22MnB5 steel sheets, commonly used in the hot stamping process of automotive components. Nakajima tests were carried out at different temperatures and the Forming Limit Diagrams (FLDs) at rupture were obtained and analysed. The temperature influenced both the major and the minor strain at which the sheet failed, indicating that not only the formability increased at increasing temperature, but there was also a modification of the strain path, which means a modification of the strain states through which the part passes during the deformation process. Moreover, the influence of friction is studied using a model developed in the LS-Dyna FEM environment. The obtained data are of great importance for an accurate calibration of Finite Element (FE) models of the hot stamping of real components in order to get optimal process parameters to obtain defects-free pieces.

CO2 Laser Cutting of Hot Stamping Boron Steel Sheets

OpenAIRE

Pasquale Russo Spena

2017-01-01

This study investigates the quality of CO2 laser cutting of hot stamping boron steel sheets that are employed in the fabrication of automotive body-in-white. For this purpose, experimental laser cutting tests were conducted on 1.2 mm sheets at varying levels of laser power, cutting speed, and oxygen pressure. The resulting quality of cut edges was evaluated in terms of perpendicularity tolerance, surface irregularity, kerf width, heat affected zone, and dross extension. Experimental tests wer...

Tribological behavior of a new green industrial lubricant for stamping operations - Application to Stainless Steels

Science.gov (United States)

Buteri, A.; Borgeot, M.; Roizard, X.; Lallemand, F.; Melot, J.-M.; Morand, L.

2016-11-01

Thanks to a fruitful collaboration between different academic and industrial research entities, a new green lubricant solution AFULudine has been developed for stamping operations in substitution to the usual mineral oils, with the idea and the wish to combine different essential properties such as a low environmental impact and ease-of-use according to the market needs and the more and more restrictive environmental legislation (e.g. REACH). Based on the Self-Assembled-Monolayer (SAM) principle and so, on a perfect control of the chemical reaction between the solution and the substrate (grafting of molecules onto the surface), AFULudine offers an efficient technical answer for improving stamping processes. The present study, focused on stainless steel stampings (comparison between a 441-1.4509 grade and a 304-1.4301 grade), investigates the performances of this new green industrial lubricant at different levels: from laboratory tests to industrial conditions through the production of hundreds of parts. Additional results coming from tests made on a rotational pin- on-disk tribometer will allow us to appreciate and retrieve more local information about the tribofilm creation during sliding. Moreover, the comparison with different mineral oils currently used at industrial scale, will strengthen the AFULudine performances. Indeed, this new solution usually outperforms a majority of such oils whatever their viscosity and their own composition: formulation, content of extreme pressure additives (Cl, S, P)...

Medicaid and CHIP Payment and Access Commission - statistics

Data.gov (United States)

U.S. Department of Health & Human Services — MACStats includes state-specific information about program enrollment, spending, eligibility levels, optional Medicaid benefits covered, and the federal medical...

The Impact of Continuous Medicaid Enrollment on Diagnosis, Treatment, and Survival in Six Surgical Cancers

Science.gov (United States)

Dawes, Aaron J; Louie, Rachel; Nguyen, David K; Maggard-Gibbons, Melinda; Parikh, Punam; Ettner, Susan L; Ko, Clifford Y; Zingmond, David S

2014-01-01

Objective To examine the effect of Medicaid enrollment on the diagnosis, treatment, and survival of six surgically relevant cancers among poor and underserved Californians. Data Sources California Cancer Registry (CCR), California's Patient Discharge Database (PDD), and state Medicaid enrollment files between 2002 and 2008. Study Design We linked clinical and administrative records to differentiate patients continuously enrolled in Medicaid from those receiving coverage at the time of their cancer diagnosis. We developed multivariate logistic regression models to predict death within 1 year for each cancer after controlling for sociodemographic and clinical variables. Data Collection/Extraction Methods All incident cases of six cancers (colon, esophageal, lung, pancreas, stomach, and ovarian) were identified from CCR. CCR records were linked to hospitalizations (PDD) and monthly Medicaid enrollment. Principal Findings Continuous enrollment in Medicaid for at least 6 months prior to diagnosis improves survival in three surgically relevant cancers. Discontinuous Medicaid patients have higher stage tumors, undergo fewer definitive operations, and are more likely to die even after risk adjustment. Conclusions Expansion of continuous insurance coverage under the Affordable Care Act is likely to improve both access and clinical outcomes for cancer patients in California. PMID:25256223

Methods University Health System Can Use to Expand Medicaid Coverage to Uninsured Poor Parents with Medicaid Eligible Children: Policy Analysis

National Research Council Canada - National Science Library

McMahon, III, Robert T

2006-01-01

.... A 1115 Medicaid waiver requiring a premium cost share with small business, employees, and county indigent care funds is currently the best long-term solution and will increase access and assist...

Diagnostic Risk Adjustment for Medicaid: The Disability Payment System

Science.gov (United States)

Kronick, Richard; Dreyfus, Tony; Lee, Lora; Zhou, Zhiyuan

1996-01-01

This article describes a system of diagnostic categories that Medicaid programs can use for adjusting capitation payments to health plans that enroll people with disability. Medicaid claims from Colorado, Michigan, Missouri, New York, and Ohio are analyzed to demonstrate that the greater predictability of costs among people with disabilities makes risk adjustment more feasible than for a general population and more critical to creating health systems for people with disability. The application of our diagnostic categories to State claims data is described, including estimated effects on subsequent-year costs of various diagnoses. The challenges of implementing adjustment by diagnosis are explored. PMID:10172665

Disruption of Ttll5/Stamp Gene (Tubulin Tyrosine Ligase-like Protein 5/SRC-1 and TIF2-associated Modulatory Protein Gene) in Male Mice Causes Sperm Malformation and Infertility*

Science.gov (United States)

Lee, Geun-Shik; He, Yuanzheng; Dougherty, Edward J.; Jimenez-Movilla, Maria; Avella, Matteo; Grullon, Sean; Sharlin, David S.; Guo, Chunhua; Blackford, John A.; Awasthi, Smita; Zhang, Zhenhuan; Armstrong, Stephen P.; London, Edra C.; Chen, Weiping; Dean, Jurrien; Simons, S. Stoney

2013-01-01

TTLL5/STAMP (tubulin tyrosine ligase-like family member 5) has multiple activities in cells. TTLL5 is one of 13 TTLLs, has polyglutamylation activity, augments the activity of p160 coactivators (SRC-1 and TIF2) in glucocorticoid receptor-regulated gene induction and repression, and displays steroid-independent growth activity with several cell types. To examine TTLL5/STAMP functions in whole animals, mice were prepared with an internal deletion that eliminated several activities of the Stamp gene. This mutation causes both reduced levels of STAMP mRNA and C-terminal truncation of STAMP protein. Homozygous targeted mutant (Stamptm/tm) mice appear normal except for marked decreases in male fertility associated with defects in progressive sperm motility. Abnormal axonemal structures with loss of tubulin doublets occur in most Stamptm/tm sperm tails in conjunction with substantial reduction in α-tubulin polyglutamylation, which closely correlates with the reduction in mutant STAMP mRNA. The axonemes in other structures appear unaffected. There is no obvious change in the organs for sperm development of WT versus Stamptm/tm males despite the levels of WT STAMP mRNA in testes being 20-fold higher than in any other organ examined. This defect in male fertility is unrelated to other Ttll genes or 24 genes previously identified as important for sperm function. Thus, STAMP appears to participate in a unique, tissue-selective TTLL-mediated pathway for α-tubulin polyglutamylation that is required for sperm maturation and motility and may be relevant for male fertility. PMID:23558686

CMS Medicare and Medicaid EHR Incentive Program, Electronic Health Record Products Used for Attestation

Data.gov (United States)

U.S. Department of Health & Human Services — Data set merges information about the Centers for Medicare and Medicaid Services, Medicare and Medicaid EHR Incentive Programs attestations with the Office of the...

Occupational Therapy in Medicaid Home and Community-Based Services Waivers.

Science.gov (United States)

Friedman, Carli; VanPuymbrouck, Laura

Medicaid Home and Community-Based Services (HCBS) 1915(c) waivers are the largest provider of long-term services and supports for people with intellectual and developmental disabilities (IDDs). In this study, we explored how HCBS IDD waivers projected providing occupational therapy services in Fiscal Year (FY) 2015. Medicaid HCBS IDD waivers across the nation gathered from the Centers for Medicare and Medicaid Services were qualitatively and quantitatively analyzed to determine how they projected providing occupational therapy services in terms of service expenditures and utilization. In FY 2015, $14.13 million of spending was projected for occupational therapy services of 7,500 participants. However, there was large heterogeneity across states and services in terms of total projected spending, spending per participant, and reimbursement rates. Comparisons across states strengthen the profession's ability to assert the value of its services. These findings can help identify best practices and can advocate for the refinement of state occupational therapy programs. Copyright © 2018 by the American Occupational Therapy Association, Inc.

Occupational Therapy in Medicaid Home and Community-Based Services Waivers

Science.gov (United States)

VanPuymbrouck, Laura

2018-01-01

OBJECTIVE. Medicaid Home and Community-Based Services (HCBS) 1915(c) waivers are the largest provider of long-term services and supports for people with intellectual and developmental disabilities (IDDs). In this study, we explored how HCBS IDD waivers projected providing occupational therapy services in Fiscal Year (FY) 2015. METHOD. Medicaid HCBS IDD waivers across the nation gathered from the Centers for Medicare and Medicaid Services were qualitatively and quantitatively analyzed to determine how they projected providing occupational therapy services in terms of service expenditures and utilization. RESULTS. In FY 2015, $14.13 million of spending was projected for occupational therapy services of 7,500 participants. However, there was large heterogeneity across states and services in terms of total projected spending, spending per participant, and reimbursement rates. CONCLUSION. Comparisons across states strengthen the profession’s ability to assert the value of its services. These findings can help identify best practices and can advocate for the refinement of state occupational therapy programs. PMID:29426389

Authentication, Time-Stamping and Digital Signatures

Science.gov (United States)

Levine, Judah

1996-01-01

Time and frequency data are often transmitted over public packet-switched networks, and the use of this mode of distribution is likely to increase in the near future as high-speed logical circuits transmitted via networks replace point-to-point physical circuits. ALthough these networks have many technical advantages, they are susceptible to evesdropping, spoofing, and the alteration of messages enroute using techniques that are relatively simple to implement and quite difficult to detect. I will discuss a number of solutions to these problems, including the authentication mechanism used in the Network Time Protocol (NTP) and the more general technique of signing time-stamps using public key cryptography. This public key method can also be used to implement the digital analog of a Notary Public, and I will discuss how such a system could be realized on a public network such as the Internet.

Counterproductive Consequences of a Conservative Ideology: Medicaid Expansion and Personal Responsibility Requirements.

Science.gov (United States)

Baker, Allison M; Hunt, Linda M

2016-07-01

Medicaid expansion, a key part of the Affordable Care Act, has been opposed by conservative politicians despite its fiscal and public health benefits. In response, some Republican-led states have expanded Medicaid with new reforms, including requirements for cost sharing and behavioral incentives, that promote conservative political values tied to an ideology of personal responsibility. We examine this trend using Michigan's Medicaid expansion as a case example. We explore the origins, evidence base, and possible consequences of these reforms. We argue that these reforms prioritize ideology over sound public health knowledge, deflecting attention away from the social, economic, and structural factors that influence the health of the poor, and may ultimately contribute to counterproductive public health and fiscal outcomes.

CO2 Laser Cutting of Hot Stamping Boron Steel Sheets

Directory of Open Access Journals (Sweden)

Pasquale Russo Spena

2017-10-01

Full Text Available This study investigates the quality of CO2 laser cutting of hot stamping boron steel sheets that are employed in the fabrication of automotive body-in-white. For this purpose, experimental laser cutting tests were conducted on 1.2 mm sheets at varying levels of laser power, cutting speed, and oxygen pressure. The resulting quality of cut edges was evaluated in terms of perpendicularity tolerance, surface irregularity, kerf width, heat affected zone, and dross extension. Experimental tests were based on a L9(34 orthogonal array design, with the effects of the process parameters on the quality responses being determined by means of a statistical analysis of variance (ANOVA. Quadratic mathematical models were developed to determine the relationships between the cutting parameters and the quality responses. Finally, a routine based on an optimization criterion was employed to predict the optimal setting of cutting factors and its effect on the quality responses. A confirmation experiment was conducted to verify the appropriateness of the optimization routine. The results show that all of the examined process parameters have a key role in determining the cut quality of hot stamping boron steel sheets, with cutting speed and their interactions having the most influencing effects. Particularly, interactions can have an opposite behavior for different levels of the process parameters.

Association of State Access Standards With Accessibility to Specialists for Medicaid Managed Care Enrollees.

Science.gov (United States)

Ndumele, Chima D; Cohen, Michael S; Cleary, Paul D

2017-10-01

Medicaid recipients have consistently reported less timely access to specialists than patients with other types of coverage. By 2018, state Medicaid agencies will be required by the Center for Medicare and Medicaid Services (CMS) to enact time and distance standards for managed care organizations to ensure an adequate supply of specialist physicians for enrollees; however, there have been no published studies of whether these policies have significant effects on access to specialty care. To compare ratings of access to specialists for adult Medicaid and commercial enrollees before and after the implementation of specialty access standards. We used Consumer Assessment of Healthcare Providers and Systems survey data to conduct a quasiexperimental difference-in-differences (DID) analysis of 20 163 nonelderly adult Medicaid managed care (MMC) enrollees and 54 465 commercially insured enrollees in 5 states adopting access standards, and 37 290 MMC enrollees in 5 matched states that previously adopted access standards. Reported access to specialty care in the previous 6 months. Seven thousand six hundred ninety-eight (69%) Medicaid enrollees and 28 423 (75%) commercial enrollees reported that it was always or usually easy to get an appointment with a specialist before the policy implementation (or at baseline) compared with 11 889 (67%) of Medicaid enrollees in states that had previously implemented access standards. Overall, there was no significant improvement in timely access to specialty services for MMC enrollees in the period following implementation of standard(s) (adjusted difference-in-differences, -1.2 percentage points; 95% CI, -2.7 to 0.1), nor was there any impact of access standards on insurance-based disparities in access (0.6 percentage points; 95% CI, -4.3 to 5.4). There was heterogeneity across states, with 1 state that implemented both time and distance standards demonstrating significant improvements in access and reductions in disparities

Children's Budget 2015

Science.gov (United States)

Kyle, Sarah, Ed.

2015-01-01

The federal government makes more than 200 distinct investments in children. These include traditional children's initiatives like education and child abuse and neglect prevention. They also include other investments that improve the lives of kids, like Medicaid and the Supplemental Nutrition Assistance Program (formerly Food Stamps). Following a…

78 FR 57857 - Medicare and Medicaid Programs; Application from the Compliance Team for Initial CMS-Approval of...

Science.gov (United States)

2013-09-20

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-3287-PN] Medicare and Medicaid Programs; Application from the Compliance Team for Initial CMS-Approval of its Rural Health Clinic Accreditation Program AGENCY: Centers for Medicare and Medicaid Services, HHS. ACTION...

Recent changes in Medicaid policy and their possible effects on mental health services.

Science.gov (United States)

Buck, Jeffrey A

2009-11-01

As Medicaid has emerged as the primary funder of public mental health services, its character has affected the organization and delivery of such services. Recent changes to the program, however, promise to further affect the direction of changes in states' mental health service systems. One group of changes will further limit the flexibility of Medicaid mental health funding, while increasing provider accountability and the authority of state Medicaid agencies. Others will increase incentives for deinstitutionalization and community-based care and promote person-centered treatment principles. These changes will likely affect state mental health systems, mental health providers, and the nature of service delivery.

Long-term disease and economic outcomes of prior authorization criteria for Hepatitis C treatment in Pennsylvania Medicaid.

Science.gov (United States)

Kabiri, Mina; Chhatwal, Jagpreet; Donohue, Julie M; Roberts, Mark S; James, A Everette; Dunn, Michael A; Gellad, Walid F

2017-09-01

Several highly effective but costly therapies for hepatitis C virus (HCV) are available. As a consequence of their high price, 36 state Medicaid programs limited treatment coverage to patients with more advanced HCV stages. States have only limited information available to predict the long-term impact of these decisions. We adapted a validated hepatitis C microsimulation model to the Pennsylvania Medicaid population to estimate the existing HCV prevalence in Pennsylvania Medicaid and estimate the impact of various HCV drug coverage policies on disease outcomes and costs. Outcome measures included rates of advanced-stage HCV outcomes and treatment and disease costs in both Medicaid and Medicare. We estimated that 46,700 individuals in Pennsylvania Medicaid were infected with HCV in 2015, 33% of whom were still undiagnosed. By expanding treatment to include mild fibrosis stage (Metavir F2), Pennsylvania Medicaid will spend an additional $273 million on medications in the next decade with no substantial reduction in the incidence of liver cancer or liver-related death. Medicaid patients who are not eligible for treatment under restricted policies would get treatment once they transition to the Medicare program, which would incur 10% reduction in HCV-related costs due to early treatment in Medicaid. Further expanding treatment to patients with early fibrosis stages (F0 or F1) would cost Medicaid an additional $693 million during the next decade but would reduce the number of individuals in need of treatment in Medicare by 46% and decrease Medicare treatment costs by 23%. In some scenarios, outcomes could worsen with eligibility expansion if there is inadequate capacity to treat all patients. Expansion of HCV treatment coverage to less severe stages of liver disease may not substantially improve liver related outcomes for patients in Pennsylvania Medicaid in scenarios in which coverage through Medicare is widely available. Published by Elsevier Inc.

Can Food Stamps Do More to Improve Food Choices? An Economic Perspective--Making Healthy Food Choices Easier: Ideas From Behavioral Economics

OpenAIRE

Mancino, Lisa; Andrews, Margaret S.

2007-01-01

With obesity the most prevalent nutrition problem facing Americans at all economic levels, promoting diets that provide adequate nutrition without too many calories has become an important objective for the Food Stamp Program. Findings from behavioral economics suggest innovative, low-cost ways to improve the diet quality of food stamp participants without restricting their freedom of choice. Unlike more traditional economic interventions, such as changing prices or banning specific foods, th...

Association Between Health Plan Exit From Medicaid Managed Care and Quality of Care, 2006-2014.

Science.gov (United States)

Ndumele, Chima D; Schpero, William L; Schlesinger, Mark J; Trivedi, Amal N

2017-06-27

State Medicaid programs have increasingly contracted with insurers to provide medical care services for enrollees (Medicaid managed care plans). Insurers that provide these plans can exit Medicaid programs each year, with unclear effects on quality of care and health care experiences. To determine the frequency and interstate variation of health plan exit from Medicaid managed care and evaluate the relationship between health plan exit and market-level quality. Retrospective cohort of all comprehensive Medicaid managed care plans (N = 390) during the interval 2006-2014. Plan exit, defined as the withdrawal of a managed care plan from a state's Medicaid program. Eight measures from the Healthcare Effectiveness Data and Information Set were used to construct 3 composite indicators of quality (preventive care, chronic disease care management, and maternity care). Four measures from the Consumer Assessment of Healthcare Providers and Systems were combined into a composite indicator of patient experience, reflecting the proportion of beneficiaries rating experiences as 8 or above on a 0-to-10-point scale. Outcome data were available for 248 plans (68% of plans operating prior to 2014, representing 78% of beneficiaries). Of the 366 comprehensive Medicaid managed care plans operating prior to 2014, 106 exited Medicaid. These exiting plans enrolled 4 848 310 Medicaid beneficiaries, with a mean of 606 039 beneficiaries affected by plan exits annually. Six states had a mean of greater than 10% of Medicaid managed care recipients enrolled in plans that exited, whereas 10 states experienced no plan exits. Plans that exited from a state's Medicaid market performed significantly worse prior to exiting than those that remained in terms of preventive care (57.5% vs 60.4%; difference, 2.9% [95% CI, 0.3% to 5.5%]), maternity care (69.7% vs 73.6%; difference, 3.8% [95% CI, 1.7% to 6.0%]), and patient experience (73.5% vs 74.8%; difference, 1.3% [95% CI, 0.6% to 1

State-County Profiles of Medicare-Medicaid dual Benes

Data.gov (United States)

U.S. Department of Health & Human Services — This 6-page document provides key statistics on Medicare-Medicaid dual enrollees enrollment, service utilization, expenditures, and chronic conditions for 2012. 2012...

Extracting Hot spots of Topics from Time Stamped Documents

Science.gov (United States)

Chen, Wei; Chundi, Parvathi

2011-01-01

Identifying time periods with a burst of activities related to a topic has been an important problem in analyzing time-stamped documents. In this paper, we propose an approach to extract a hot spot of a given topic in a time-stamped document set. Topics can be basic, containing a simple list of keywords, or complex. Logical relationships such as and, or, and not are used to build complex topics from basic topics. A concept of presence measure of a topic based on fuzzy set theory is introduced to compute the amount of information related to the topic in the document set. Each interval in the time period of the document set is associated with a numeric value which we call the discrepancy score. A high discrepancy score indicates that the documents in the time interval are more focused on the topic than those outside of the time interval. A hot spot of a given topic is defined as a time interval with the highest discrepancy score. We first describe a naive implementation for extracting hot spots. We then construct an algorithm called EHE (Efficient Hot Spot Extraction) using several efficient strategies to improve performance. We also introduce the notion of a topic DAG to facilitate an efficient computation of presence measures of complex topics. The proposed approach is illustrated by several experiments on a subset of the TDT-Pilot Corpus and DBLP conference data set. The experiments show that the proposed EHE algorithm significantly outperforms the naive one, and the extracted hot spots of given topics are meaningful. PMID:21765568

78 FR 41013 - Medicare and Medicaid Programs; Home Health Prospective Payment System Rate Update for CY 2014...

Science.gov (United States)

2013-07-09

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 431 [CMS-1450-CN] RIN 0938-AR52 Medicare and Medicaid Programs; Home Health Prospective Payment System Rate... period titled ``Medicare and Medicaid Programs; Home Health Prospective Payment System Rate Update for CY...

78 FR 46339 - Medicare, Medicaid, and Children's Health Insurance Programs: Announcement of Temporary Moratoria...

Science.gov (United States)

2013-07-31

...] Medicare, Medicaid, and Children's Health Insurance Programs: Announcement of Temporary Moratoria on... combat fraud, waste, and abuse in Medicare, Medicaid, and the Children's Health Insurance Program (CHIP... Health Insurance Programs; Additional Screening Requirements, Application Fees, Temporary Enrollment...

Medicaid Expenditures for Fee-for-Service Enrollees with Behavioral Diagnoses: Findings from a 50 State Claims Analysis.

Science.gov (United States)

Ward, Martha C; Lally, Cathy; Druss, Benjamin G

2017-01-01

Medicaid is an important funder of care for individuals with behavioral (psychiatric and/or substance use) diagnoses, and expenditures will likely increase with expansion of services under the Affordable Care Act. This study provides national estimates of Medicaid expenditures using a comprehensive sample of fee-for-service Medicaid enrollees with behavioral diagnoses. Data for analysis came from 2003 to 2004 Medicaid Analytic eXtract (MAX) files for 50 states and the District of Columbia. Individuals with behavioral diagnoses had high rates of chronic medical comorbidities, and expenditures for medical (non-behavioral) diagnoses accounted for 74 % of their health care expenditures. Total Medicaid expenditure was approximately 15 billion dollars (equivalent to 18.91 billion in 2016 dollars) for individuals with any behavioral diagnosis. Medicaid fee-for-service beneficiaries with behavioral diagnoses have a high treated prevalence of individual medical comorbid conditions, and the majority of health care expenditures in these individuals are for medical, rather than behavioral health, services.

Prevalence and covariates of food insecurity among residents of single-room occupancy housing in Chicago, IL, USA.

Science.gov (United States)

Bowen, Elizabeth A; Bowen, Sarah K; Barman-Adhikari, Anamika

2016-04-01

Emerging evidence suggests that food insecurity is a significant public health concern among people who are homeless or marginally housed. The present study assessed prevalence of food insecurity and its covariates among a group of marginally housed individuals living in single-room occupancy (SRO) dwellings, a population for which there is little extant health or nutrition research. Cross-sectional survey incorporating the Household Food Insecurity Access Scale. Ten private SRO residences in the Uptown neighbourhood of Chicago, IL, USA, 2013. SRO residents over 18 years of age who were able to communicate verbally in English (n 153). Food insecurity was widespread among SRO residents, with 75 % of the sample considered food insecure and 52 % meeting criteria for severe food insecurity. Bivariate analyses indicated that female gender, eating most meals at a soup kitchen, having a mental health condition, problem drinking, having at least one chronic health condition, and diabetes were all significantly associated with food insecurity. In the multivariate ordered logistic regression model, eating most meals at a soup kitchen remained as the only significant correlate of food insecurity (OR=10·13). SRO residents and other marginally housed populations face unique food access challenges. Although targeted assistance in the form of food stamps and congregate meal programmes remains critical, efforts to prevent and address food insecurity among homeless and marginally housed individuals should include policy interventions that recognize poverty as the root cause of food insecurity and aim to increase overall income and improve housing conditions.

Health and federal budgetary effects of increasing access to antiretroviral medications for HIV by expanding Medicaid.

Science.gov (United States)

Kahn, J G; Haile, B; Kates, J; Chang, S

2001-09-01

OBJECTIVES. This study modeled the health and federal fiscal effects of expanding Medicaid for HIV-infected people to improve access to highly active antiretroviral therapy. A disease state model of the US HIV epidemic, with and without Medicaid expansion, was used. Eligibility required a CD4 cell count less than 500/mm3 or viral load greater than 10,000, absent or inadequate medication insurance, and annual income less than $10,000. Two benefits were modeled, "full" and "limited" (medications, outpatient care). Federal spending for Medicaid, Medicare, AIDS Drug Assistance Program, Supplemental Security Income, and Social Security Disability Insurance were assessed. An estimated 38,000 individuals would enroll in a Medicaid HIV expansion. Over 5 years, expansion would prevent an estimated 13,000 AIDS diagnoses and 2600 deaths and add 5,816 years of life. Net federal costs for all programs are $739 million (full benefits) and $480 million (limited benefits); for Medicaid alone, the costs are $1.43 and $1.17 billion, respectively. Results were sensitive to awareness of serostatus, highly active antiretroviral therapy cost, and participation rate. Strategies for federal cost neutrality include Medicaid HIV drug price reductions as low as 9% and private insurance buy-ins. Expansion of the Medicaid eligibility to increase access to antiretroviral therapy would have substantial health benefits at affordable costs.

Prevalence and Correlates of Smoking among Low-Income Adults Residing in New York City Public Housing Developments-2015.

Science.gov (United States)

Feinberg, A; Lopez, P M; Wyka, K; Islam, N; Seidl, L; Drackett, E; Mata, A; Pinzon, J; Baker, M R; Lopez, J; Trinh-Shevrin, C; Shelley, D; Bailey, Z; Maybank, K A; Thorpe, L E

2017-08-01

To guide targeted cessation and prevention programming, this study assessed smoking prevalence and described sociodemographic, health, and healthcare use characteristics of adult smokers in public housing. Self-reported data were analyzed from a random sample of 1664 residents aged 35 and older in ten New York City public housing developments in East/Central Harlem. Smoking prevalence was 20.8%. Weighted log-binomial models identified to be having Medicaid, not having a personal doctor, and using health clinics for routine care were positively associated with smoking. Smokers without a personal doctor were less likely to receive provider quit advice. While most smokers in these public housing developments had health insurance, a personal doctor, and received provider cessation advice in the last year (72.4%), persistently high smoking rates suggest that such cessation advice may be insufficient. Efforts to eliminate differences in tobacco use should consider place-based smoking cessation interventions that extend cessation support beyond clinical settings.

Understanding the recent growth in Medicaid spending, 2000-2003.

Science.gov (United States)

Holahan, John; Ghosh, Arunabh

2005-01-01

Growth in Medicaid spending averaged 10.2 percent per year between 2000 and 2003, resulting in a one-third increase in program spending. Spending growth was lower from 2002 to 2003 because of slower growth in enrollment and in spending per enrollee, particularly for acute care services, and declines in disproportionate-share hospital (DSH) payments and upper payment limit (UPL) programs. For the entire 2000-2003 period, Medicaid spending increases were largely driven by enrollment growth, much of which was attributable to the economic downturn. Increases in spending per enrollee over the period were faster than inflation but slower than increases in private insurance spending.

Disabling health care? Medicaid managed care and people with disabilities in America

DEFF Research Database (Denmark)

Hiranandani, Vanmala Sunder

2011-01-01

Medicaid, America's largest government-funded health insurance program, plays a pivotal role in providing health services to eight million adults with disabilities. Since the mid-1990s, many Medicaid programs have aggressively introduced managed care, which reconfigures service delivery using...... business principles. Most states have insufficient experience in developing managed care plans for Medicaid beneficiaries with disabilities. Middle-aged adults with physical disabilities present their own constellation of health care issues that is not readily appreciated in health and social services....... The purpose of the study was to understand their experiences in accessing physical health care services and to ascertain the effects of managed care on their health and well-being. This study found beneficiaries encounter numerous barriers in accessing preventative, treatment, and acute care services. Overall...

Express Lane Eligibility for Medicaid and CHIP Coverage

Data.gov (United States)

U.S. Department of Health & Human Services — States may rely on eligibility information from "Express Lane" agency programs to streamline and simplify enrollment and renewal in Medicaid and CHIP. Express Lane...

Drug Products in the Medicaid Drug Rebate Program

Data.gov (United States)

U.S. Department of Health & Human Services — Active drugs that have been reported by participating drug manufacturers under the Medicaid Drug Rebate Program. All drugs are identified by National Drug Code...

Increased Use of Care Management Processes and Expanded Health Information Technology Functions by Practice Ownership and Medicaid Revenue.

Science.gov (United States)

Rodriguez, Hector P; McClellan, Sean R; Bibi, Salma; Casalino, Lawrence P; Ramsay, Patricia P; Shortell, Stephen M

2016-06-01

Practice ownership and Medicaid revenue may affect the use of care management processes (CMPs) for chronic conditions and expansion of health information technology (HIT). Using a national cohort of medical practices, we compared the use of CMPs and HIT from 2006/2008 to 2013 by practice ownership and level of Medicaid revenue. Poisson regression models estimated changes in CMP use, and linear regression estimated changes in HIT, by practice ownership and Medicaid patient revenue, controlling for other practice characteristics. Compared with physician-owned practices, system-owned practices adopted a greater number of CMPs and HIT functions over time (p < .001). High Medicaid revenue (≥30.0%) was associated with less adoption of CMPs (p < .001) and HIT (p < .01). System-owned practices (p < .001) and community health centers (p < .001) with high Medicaid revenue were more likely than physician-owned practices with high Medicaid revenue to adopt CMPs over time. System and community health center ownership appear to help high Medicaid practices overcome CMP adoption constraints. © The Author(s) 2015.

A Path-Independent Forming Limit Criterion for Stamping Simulations

International Nuclear Information System (INIS)

Zhu Xinhai; Chappuis, Laurent; Xia, Z. Cedric

2005-01-01

Forming Limit Diagram (FLD) has been proved to be a powerful tool for assessing necking failures in sheet metal forming analysis for majority of stamping operations over the last three decades. However, experimental evidence and theoretical analysis suggest that its applications are limited to linear or almost linear strain paths during its deformation history. Abrupt changes or even gradual deviations from linear strain-paths will shift forming limit curves from their original values, a situation that occurs in vast majority of sequential stamping operations such as where the drawing process is followed by flanging and re-strike processes. Various forming limit models have been put forward recently to provide remedies for the problem, noticeably stress-based and strain gradient-based forming limit criteria. This study presents an alternative path-independent forming limit criterion. Instead of traditional Forming Limit Diagrams (FLD) which are constructed in terms of major - minor principal strains throughout deformation history, the new criterion defines a critical effective strain ε-bar* as the limit strain for necking, and it is shown that ε-bar* can be expressed as a function of current strain rate state and material work hardening properties, without the need of explicitly considering strain-path effects. It is given by ε-bar* = f(β, k, n) where β = (dε 2 /dε 1 ) at current deformation state, and k and n are material strain hardening parameters if a power law is assumed. The analysis is built upon previous work by Storen and Rice [1975] and Zhu et al [2002] with the incorporation of anisotropic yield models such as Hill'48 for quadratic orthotropic yield and Hill'79 for non-quadratic orthotropic yield. Effects of anisotropic parameters such as R-values and exponent n-values on necking are investigated in detail for a variety of strain paths. Results predicted according to current analysis are compared against experimental data gathered from literature

Medicare and Medicaid Trends in Health Care Sectors

Data.gov (United States)

U.S. Department of Health & Human Services — The Centers for Medicare and Medicaid Services (CMS) provides monthly and fiscal-year-to-date income and expenditure trends for Medicare Hospital Insurance (HI) and...

Bias due to sample selection in propensity score matching for a supportive housing program evaluation in New York City.

Directory of Open Access Journals (Sweden)

Sungwoo Lim

Full Text Available OBJECTIVES: Little is known about influences of sample selection on estimation in propensity score matching. The purpose of the study was to assess potential selection bias using one-to-one greedy matching versus optimal full matching as part of an evaluation of supportive housing in New York City (NYC. STUDY DESIGN AND SETTINGS: Data came from administrative data for 2 groups of applicants who were eligible for an NYC supportive housing program in 2007-09, including chronically homeless adults with a substance use disorder and young adults aging out of foster care. We evaluated the 2 matching methods in their ability to balance covariates and represent the original population, and in how those methods affected outcomes related to Medicaid expenditures. RESULTS: In the population with a substance use disorder, only optimal full matching performed well in balancing covariates, whereas both methods created representative populations. In the young adult population, both methods balanced covariates effectively, but only optimal full matching created representative populations. In the young adult population, the impact of the program on Medicaid expenditures was attenuated when one-to-one greedy matching was used, compared with optimal full matching. CONCLUSION: Given covariate balancing with both methods, attenuated program impacts in the young adult population indicated that one-to-one greedy matching introduced selection bias.

78 FR 6275 - Medicaid, Children's Health Insurance Programs, and Exchanges: Essential Health Benefits in...

Science.gov (United States)

2013-01-30

... Medicaid, Children's Health Insurance Programs, and Exchanges: Essential Health Benefits in Alternative...'s Health Insurance Programs, and Exchanges: Essential Health Benefits in Alternative Benefit Plans... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 430...

Access to Transportation and Health Care Visits for Medicaid Enrollees With Diabetes.

Science.gov (United States)

Thomas, Leela V; Wedel, Kenneth R; Christopher, Jan E

2018-03-01

Diabetes is a chronic condition that requires frequent health care visits for its management. Individuals without nonemergency medical transportation often miss appointments and do not receive optimal care. This study aims to evaluate the association between Medicaid-provided nonemergency medical transportation and diabetes care visits. A retrospective analysis was conducted of demographic and claims data obtained from the Oklahoma Medicaid program. Participants consisted of Medicaid enrollees with diabetes who made at least 1 visit for diabetes care in a year. The sample was predominantly female and white, with an average age of 46.38 years. Two zero-truncated Poisson regression models were estimated to assess the independent effect of transportation use on number of diabetes care visits. Use of nonemergency medical transportation is a significant predictor of diabetes care visits. Zero-truncated Poisson regression coefficients showed a positive association between the use of transportation and number of visits (0.6563, P urban; women made fewer visits than men (-0.09312; P transportation to Medicaid populations with diabetes, particularly in the rural areas where the prevalence of diabetes and complications are higher and the availability of medical resources lower than in the urban areas. © 2017 National Rural Health Association.

Organic thin film transistors and polymer light-emitting diodes patterned by polymer inking and stamping

International Nuclear Information System (INIS)

Li Dawen; Guo, L Jay

2008-01-01

To fully realize the advantages of organic flexible electronics, patterning is very important. In this paper we show that a purely additive patterning technique, termed polymer inking and stamping, can be used to pattern conductive polymer PEDOT and fabricate sub-micron channel length organic thin film transistors. In addition, we applied the technique to transfer a stack of metal/conjugated polymer in one step and fabricated working polymer light-emitting devices. Based on the polymer inking and stamping technique, a roll-to-roll printing for high throughput fabrication has been demonstrated. We investigated and explained the mechanism of this process based on the interfacial energy consideration and by using the finite element analysis. This technique can be further extended to transfer more complex stacked layer structures, which may benefit the research on patterning on flexible substrates

Medicaid Analytic eXtract (MAX) Rx Table Listing

Data.gov (United States)

U.S. Department of Health & Human Services — The Statistical Compendium table listing (below) enables users to choose to view Medicaid prescription drug tables for 1999 - 2009, and to select the tables for the...

Medicaid Managed Care Penetration Rates and Expansion Enr...

Data.gov (United States)

U.S. Department of Health & Human Services — The Medicaid managed care penetration rates and expansion enrollment by state charts are composed annually by the Data and System Group (DSG) of the Centers for...

Medicaid waivers and negotiated federalism in the US: is there relevance to other federal systems?

Science.gov (United States)

Weissert, Carol S; Weissert, William G

2017-01-01

Medicaid waivers have been a principal tool of innovation in health policy in the US since at least the mid 1970s. As Republicans seek to give the states more flexibility in their implementation and management of both Medicaid and the Affordable Care Act or its replacement, waiver authority is likely to be one of the key work arounds for avoiding political barriers in the US Senate. While block-granting Medicaid may require 60 senate votes, waiver authority already exists in both Medicaid law and the Affordable Care Act. Waivers also have great potential for application in other federal nations. Yet there is no theory to explain the way the application and review process evolves or the factors likely to shape the outcome. After a discussion of the theoretical underpinnings of what we call 'negotiated federalism', we apply it to examples of Medicaid waivers to see if the theory's key elements - politics, party congruence, leverage, credit taking and experience - offer a useful perspective on this federal-state interaction so important to health policy.

Effects of Pre-Strain on the Aging Behavior of Al 7075 Alloy for Hot-Stamping Capability

Directory of Open Access Journals (Sweden)

Seon-Ho Jung

2018-02-01

Full Text Available The present study investigates the significance of pre-strain on the T6 aging behavior of an Al 7075 alloy for evaluating the applicability of hot stamping. In practice, the alloy was pre-strained up to 15% during solution heat treatment at 480 °C prior to quenching, and artificial aging was conducted at 120 °C. The peak aging time and precipitation behavior were compared with the alloy with pre-straining at room temperature after quenching but immediately before the artificial aging. The results showed that increasing amounts of pre-strain tend to reduce the aging time up to 50% for achieving peak hardness, which is consistent with the alloy at the T6 condition. There is a limitation for the maximum attainable amount of pre-strain of 10% for the homogeneous distribution of strain when the alloy is strained at room temperature (RT due to the low formability. The pre-strained alloy as hot stamping exhibited lowering of the peak reaction temperatures for dissolution and formation of Guinier–Preston (GP-Zones and precipitated with increasing amounts of pre-strain towards 15% through the differential scanning calorimetry analysis, thereby confirming the shortening of the peak aging time. The present study confirms the excellent potential of the hot-stamping process to extend the capability of an Al 7075 alloy.

Increased use of dental services by children covered by Medicaid: 2000-2010.

Science.gov (United States)

Ku, Leighton; Sharac, Jessica; Bruen, Brian; Thomas, Megan; Norris, Laurie

2013-01-01

This report analyzes the use of dental services by children enrolled in Medicaid from federal fiscal years (FFY) 2000 to 2010. The number and percent of children receiving dental services under Medicaid climbed continuously over the decade. In FFY 2000, 6.3 million children ages 1 to 20 were reported to receive some form of dental care (either preventive or treatment); the number more than doubled to 15.4 million by FFY 2010. Part of the increase was because the overall number of children covered by Medicaid rose by 12 million (50%), but the percentage of children who received dental care climbed appreciably from 29.3% in FFY 2000 to 46.4% in FFY 2010. In that same time period, the number of children ages 1 to 20 receiving preventive dental services climbed from a reported 5.0 million to 13.6 million, while the percentage of children receiving preventive dental services rose from 23.2% to 40.8%. For children ages 1 to 20 who received dental treatment services, the reported number rose from 3.3 million in FFY 2000 to 7.6 million in FFY 2010. The percentage of children who obtained dental treatment services increased from 15.3% to 22.9%. In FFY 2010, about one sixth of children covered by Medicaid (15.7%) ages 6-14 had a dental sealant placed on a permanent molar. While most states have made steady progress in improving children's access to dental care in Medicaid over the past decade, there is still substantial variation across states and more remains to be done.

Does Medicaid managed care market penetration impact provider participation, costs, utilization, and access?

Science.gov (United States)

Minott, Jenny

2010-09-01

Key findings. (1) An increase in commercial plan penetration increased the liklihood [sic] that a physician would accept new Medicaid patients, but this did not significantly impact enrollee costs. (2) An increase in Medicaid-dominant HMO market penetration increased the probability that individuals reported using the ED as their primary source of care.

The Effects of State Medicaid Policies on the Dynamic Savings Patterns and Medicaid Enrollment of the Elderly

Science.gov (United States)

Gardner, Lara; Gilleskie, Donna B.

2012-01-01

Medicaid policies that may affect long-term care decisions vary across states and time. Using data from the 1993, 1995, 1998, and 2000 waves of the Assets and Health Dynamics Among the Oldest Old Survey, we estimate a dynamic empirical model of health insurance coverage, long-term care arrangement, asset and gift behavior, and health transitions…

Comparison of the methods for calculating the interfacial heat transfer coefficient in hot stamping

International Nuclear Information System (INIS)

Zhao, Kunmin; Wang, Bin; Chang, Ying; Tang, Xinghui; Yan, Jianwen

2015-01-01

This paper presents a hot stamping experimentation and three methods for calculating the Interfacial Heat Transfer Coefficient (IHTC) of 22MnB5 boron steel. Comparison of the calculation results shows an average error of 7.5% for the heat balance method, 3.7% for the Beck's nonlinear inverse estimation method (the Beck's method), and 10.3% for the finite-element-analysis-based optimization method (the FEA method). The Beck's method is a robust and accurate method for identifying the IHTC in hot stamping applications. The numerical simulation using the IHTC identified by the Beck's method can predict the temperature field with a high accuracy. - Highlights: • A theoretical formula was derived for direct calculation of IHTC. • The Beck's method is a robust and accurate method for identifying IHTC. • Finite element method can be used to identify an overall equivalent IHTC

Effect of Medicaid Managed Care on racial disparities in health care access.

Science.gov (United States)

Cook, Benjamin Lê

2007-02-01

To evaluate the impact of Medicaid Managed Care (MMC) on racial disparities in access to care consistent with the Institute of Medicine (IOM) definition of racial disparity, which excludes differences stemming from health status but includes socioeconomic status (SES)-mediated differences. Secondary data from the Adult Samples of the 1997-2001 National Health Interview Survey, metropolitan statistical area (MSA)-level Medicaid Health Maintenance Organization (MHMO) market share from the 1997 to 2001 InterStudy MSA Trend Dataset, and MSA characteristics from the 1997 to 2001 Area Resource File. I estimate multivariate regression models to compare racial disparities in doctor visits, emergency room (ER) use, and having a usual source of care between enrollees in MMC and Medicaid Fee-for-Service (FFS) plans. To contend with potential selection bias, I use a difference-in-difference analytical strategy and assess the impact of greater MHMO market share at the MSA level on Medicaid enrollees' access measures. To implement the IOM definition of racial disparity, I adjust for health status but not SES factors using a novel method to transform the distribution of health status for minority populations to approximate the white health status distribution. MMC enrollment is associated with lowered disparities in having any doctor visit in the last year for blacks, and in having any usual source of care for both blacks and Hispanics. Increasing Medicaid HMO market share lowered disparities in having any doctor visits in the last year for both blacks and Hispanics. Although disparities in most other measures were not much affected, black-white ER use disparities exist among MMC enrollees and in areas of high MHMO market share. MMC programs' reduction of some disparities suggests that recent shifts in Medicaid policy toward managed care plans have benefited minority enrollees. Future research should investigate whether black-white disparities in ER use within MMC groups

Comparing Emergency Department Use Among Medicaid and Commercial Patients Using All-Payer All-Claims Data.

Science.gov (United States)

Kim, Hyunjee; McConnell, K John; Sun, Benjamin C

2017-08-01

The high rate of emergency department (ED) use by Medicaid patients is not fully understood. The objective of this paper is (1) to provide context for ED service use by comparing Medicaid and commercial patients' differences across ED and non-ED health service use, and (2) to assess the extent to which Medicaid-commercial differences in ED use can be explained by observable factors in administrative data. Statistical decomposition methods were applied to ED, mental health, and inpatient care using 2011-2013 Medicaid and commercial insurance claims from the Oregon All Payer All Claims database. Demographics, comorbidities, health services use, and neighborhood characteristics accounted for 44% of the Medicaid-commercial difference in ED use, compared to 83% for mental health care and 75% for inpatient care. This suggests that relative to mental health and inpatient care, a large portion of ED use cannot be explained by administrative data. Models that further accounted for patient access to different primary care physicians explained an additional 8% of the Medicaid-commercial difference in ED use, suggesting that the quality of primary care may influence ED use. The remaining unexplained difference suggests that appropriately reducing ED use remains a credible target for policy makers, although success may require knowledge about patients' perceptions and behaviors as well as social determinants of health.

The Politics of Medicaid: Most Americans Are Connected to the Program, Support Its Expansion, and Do Not View It as Stigmatizing.

Science.gov (United States)

Grogan, Colleen M; Park, Sunggeun Ethan

2017-12-01

Policy Points: More than half of Americans are connected to the Medicaid program-either through their own coverage or that of a family member or close friend-and are significantly more likely to view Medicaid as important and to support increases in spending, even among conservatives. This finding helps explain why Affordable Care Act repeal efforts faced (and will continue to face) strong public backlash. Policymakers should be aware that although renaming programs within Medicaid may have increased enrollment take-up, this destigmatization effort might have also increased program confusion and reduced support for Medicaid even among enrollees who say the program is important to them. Since the 1980s, Medicaid enrollment has expanded so dramatically that by 2015 two-thirds of Americans had some connection to the program in which either they themselves, a family member, or a close friend is currently or was previously enrolled. Utilizing a nationally representative survey-the Kaiser Family Foundation Poll: Medicare and Medicaid at 50 (n = 1,849)-and employing ordinal and logistic regression analyses, our study examines 3 questions: (1) are individuals with a connection to Medicaid more likely to view the program as important, (2) are they more likely to support an increase in Medicaid spending, and (3) are they more likely to support adoption of the Medicaid expansion offered under the Affordable Care Act? For each of these questions we examine whether partisanship and views of stigma also impact support for Medicaid and, if so, whether these factors overwhelm the impact of connection to the program. Controlling for the strong effect of partisanship, people with any connection to the Medicaid program are more likely to view the program as important than those with no connection. However, when it comes to increasing spending or expanding the program, the type of connection to the program matters. In particular, adults with current and previous Medicaid coverage and

75 FR 44971 - Medicaid Program; Request for Comments on Legislative Changes To Provide Quality of Care to Children

Science.gov (United States)

2010-07-30

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-2480-NC] Medicaid Program; Request for Comments on Legislative Changes To Provide Quality of Care to Children AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice with Comments. SUMMARY: This notice...

Commentary: the importance of Medicaid expansion for criminal justice populations in the south.

Science.gov (United States)

Zaller, Nickolas D; Cloud, David H; Brinkley-Rubinstein, Lauren; Martino, Sarah; Bouvier, Benjamin; Brockmann, Brad

2017-12-01

Though the full implications of a Trump presidency for ongoing health care and criminal justice reform efforts remain uncertain, whatever policy changes are made will be particularly salient for the South, which experiences the highest incarceration rates, highest uninsured rates, and worst health outcomes in the United States. The passage of the Affordable Care Act (ACA) in 2010 was a watershed event and many states have taken advantage of opportunities created by the ACA to expand healthcare coverage to their poorest residents, and to develop partnerships between health and justice systems. Yet to date, only four have taken advantage of the benefits of healthcare reform. Expanding Medicaid would provide Southern states with the opportunity to significantly impact health outcomes for criminal justice-involved individuals. In the context of an uncertain policy landscape, we suggest the use of three strategies, focusing on advancing incremental change while safeguarding existing gains, rebranding Medicaid as a local or statewide initiative, and linking Medicaid expansion to criminal justice reform, in order to implement Medicaid expansion across the South.

Differences in utilization of dental procedures by children enrolled in Wisconsin Medicaid and Delta Dental insurance plans.

Science.gov (United States)

Bhagavatula, Pradeep; Xiang, Qun; Szabo, Aniko; Eichmiller, Fredrick; Okunseri, Christopher

2017-12-01

Few studies have directly compared dental procedures provided in public and private insurance plans for enrollees living in dental health professional shortage areas (DHPSAs). We examined the rates for the different types of dental procedures received by 0-18-year-old children living in DHPSAs and non-DHPSAs who were enrolled in Medicaid and those enrolled under Delta Dental of Wisconsin (DDW) for years 2002 to 2008. Medicaid and DDW dental claims data for 2002 to 2008 was analyzed. Enrollees were divided into DDW-DHPSA and non-DHPSA and Medicaid-DHPSA and non-DHPSA groups. Descriptive and multivariable analyses using over-dispersed Poisson regression were performed to examine the effect of living in DHPSAs and insurance type in relation to the number of procedures received. Approximately 49 and 65 percent of children living in non-DHPSAs that were enrolled in Medicaid and DDW received at least one preventive dental procedure annually, respectively. Children in DDW non-DHPSA group had 1.79 times as many preventive, 0.27 times fewer complex restorative and 0.51 times fewer endodontic procedures respectively, compared to those in Medicaid non-DHPSA group. Children enrolled in DDW-DHPSA group had 1.53 times as many preventive and 0.25 times fewer complex restorative procedures, compared to children in Medicaid-DHPSA group. DDW enrollees had significantly higher utilization rates for preventive procedures than children in Medicaid. There were significant differences across Medicaid and DDW between non-DHPSA and DHPSA for most dental procedures received by enrollees. © 2016 American Association of Public Health Dentistry.

What Happens When Persons Leave Welfare: Data from the SIPP Panel File.

Science.gov (United States)

Lamas, Enrique; McNeil, John

This document reports on a study of the likelihood of individuals participating in the Federal food stamp program and the Medicaid program and the likelihood of exiting those programs. Data were analyzed from the first panel file of the Survey of Income and Program Participation (SIPP). Special problems with representativeness and measurement…

Can Food Stamps Do More to Improve Food Choices? An Economic Perspective--Higher Cost of Food in Some Areas May Affect Food Stamp Households' Ability To Make Healthy Food Choices

OpenAIRE

Nord, Mark; Hopwood, Heather

2007-01-01

The cost of “enough food,” estimated from the amount that low- and medium-income households in a geographic area report needing to spend to just meet their food needs, differs substantially across States and among metropolitan areas. In areas with high food costs, many food-stamp recipients are likely to have inadequate food resources to support healthy food choices.

Potential Medicaid Cost Savings from Maternity Care Based..

Data.gov (United States)

U.S. Department of Health & Human Services — Medicaid pays for about half the births in the United States, at very high cost. Compared to usual obstetrical care, care by midwives at a birth center could reduce...

Does Medicaid Insurance Confer Adequate Access to Adult Orthopaedic Care in the Era of the Patient Protection and Affordable Care Act?

Science.gov (United States)

Labrum, Joseph T; Paziuk, Taylor; Rihn, Theresa C; Hilibrand, Alan S; Vaccaro, Alexander R; Maltenfort, Mitchell G; Rihn, Jeffrey A

2017-06-01

A current appraisal of access to orthopaedic care for the adult patient receiving Medicaid is important, since Medicaid expansion was written into law by the Patient Protection and Affordable Care Act (PPACA). (1) Do orthopaedic practices provide varying access to orthopaedic care for simulated patients with Medicaid insurance versus private insurance in a blinded survey? (2) What are the surveyed state-by-state Medicaid acceptance rates for adult orthopaedic practices in the current era of Medicaid expansion set forth by the PPACA? (3) Do surveyed rates of access to orthopaedic care in the adult patient population vary across practice setting (private vs academic) or vary with different Medicaid physician reimbursement rates? (4) Are there differences in the surveyed Medicaid acceptance rates for adult orthopaedic practices in states that have expanded Medicaid coverage versus states that have foregone expansion? Simulated Patient Survey: We performed a telephone survey study of orthopaedic offices in four states with Medicaid expansion. In the survey, the caller assumed a fictitious identity as a 38-year-old male who experienced an ankle fracture 1 day before calling, and attempted to secure an appointment within 2 weeks. During initial contact, the fictitious patient reported Medicaid insurance status. One month later, the fictitious patient contacted the same orthopaedic practice and reported private insurance coverage status. National Orthopaedic Survey: Private and academic orthopaedic practices operating in each state in the United States were called and asked to complete a survey assessing their practice model of Medicaid insurance acceptance. State reimbursement rates for three different Current Procedural Terminology (CPT ®) codes were collected from state Medicaid agencies. Results Simulated Patient Survey: Offices were less likely to accept Medicaid than commercial insurance (30 of 64 [47%] versus 62 of 64 [97%]; odds ratio [OR], 0.0145; 95% CI, 0

Vaccination benefits and cost-sharing policy for non-institutionalized adult Medicaid enrollees in the United States

OpenAIRE

Stewart, Alexandra M.; Lindley, Megan C.; Chang, Kristen H.M.; Cox, Marisa A.

2013-01-01

Medicaid is the largest funding source of health services for the poorest people in the United States. Medicaid enrollees have greater health care, needs, and higher health risks than other individuals in the country and, experience disproportionately low rates of preventive care. Without, Medicaid coverage, poor uninsured adults may not be vaccinated or would, rely on publicly-funded programs that provide vaccinations. We examined each programs’ policies related to benefit coverage and, copa...

Titanium nitride stamps replicating nanoporous anodic alumina films

International Nuclear Information System (INIS)

Navas, D; Sanchez, O; Asenjo, A; Jaafar, M; Baldonedo, J L; Vazquez, M; Hernandez-Velez, M

2007-01-01

Fabrication of nanostructured TiN films by magnetron sputtering using nanoporous anodic alumina films (NAAF) as substrates is reported. These hard nanostructured films could be used for pre-patterning aluminium foils and to obtain nanoporous films replicating the starting NAAF over a wide range of pore diameters and spacings. Pre-patterned Al foils are obtained by compression with pressures lower than those previously reported, then a new NAAF can be fabricated by means of only one anodization process. As an example, one of the TiN stamps was used for pre-patterning an Al foil at a pressure of 200 kg cm -2 and then it was anodized in oxalic acid solution obtaining the corresponding replica of the starting NAAF

Changes in Payer Mix and Physician Reimbursement After the Affordable Care Act and Medicaid Expansion

Science.gov (United States)

Jones, Christine D.; Scott, Serena J.; Anoff, Debra L.; Pierce, Read G.; Glasheen, Jeffrey J.

2015-01-01

Although uncompensated care for hospital-based care has fallen dramatically since the implementation of the Affordable Care Act and Medicaid expansion, the changes in hospital physician reimbursement are not known. We evaluated if payer mix and physician reimbursement by encounter changed between 2013 and 2014 in an academic hospitalist practice in a Medicaid expansion state. This was a retrospective cohort study of all general medicine inpatient admissions to an academic hospitalist group in 2013 and 2014. The proportion of encounters by payer and reimbursement/inpatient encounter were compared in 2013 versus 2014. A sensitivity analysis determined the relative contribution of different factors to the change in reimbursement/encounter. Among 37 540 and 40 397 general medicine inpatient encounters in 2013 and 2014, respectively, Medicaid encounters increased (17.3% to 30.0%, P reimbursement/encounter increased 4.2% from $79.98/encounter in 2013 to $83.36/encounter in 2014 (P reimbursement for encounter type by payer accounted for −0.7%, 0.8%, 2.0%, and 2.3% of the reimbursement change, respectively. From 2013 to 2014, Medicaid encounters increased, and uninsured and private payer encounters decreased within our hospitalist practice. Reimbursement/encounter also increased, much of which could be attributed to a change in payer mix. Further analyses of physician reimbursement in Medicaid expansion and non-expansion states would further delineate reimbursement changes that are directly attributable to Medicaid expansion. PMID:26310500

76 FR 78741 - Medicare, Medicaid, Children's Health Insurance Programs; Transparency Reports and Reporting of...

Science.gov (United States)

2011-12-19

... Parts 402 and 403 [CMS-5060-P] RIN 0938-AR33 Medicare, Medicaid, Children's Health Insurance Programs...'s Health Insurance Program (CHIP) to report annually to the Secretary certain payments or transfers... State plan under title XIX (Medicaid) or XXI of the Act (the Children's Health Insurance Program, or...

State and National Profiles of Medicare-Medicaid dual Benes

Data.gov (United States)

U.S. Department of Health & Human Services — These documents provide key statistics on Medicare-Medicaid dual enrollees enrollment, service utilization, expenditures, and chronic conditions for 2007 through 2011.

Medicaid: State and Federal Actions Have Been Taken to Improve Children's Access to Dental Services, but More Can Be Done. Testimony before the Subcommittee on Domestic Policy, Committee on Oversight and Government Reform, House of Representatives. GAO-10-112T

Science.gov (United States)

Iritani, Katherine M.

2009-01-01

In this statement, Katherine M. Iritani, Acting Director, Health Care reports that dental disease remains a significant problem for children in Medicaid. Although dental services are a mandatory benefit for the 30 million children served by Medicaid, these children often experience elevated levels of dental problems and have difficulty finding…

Social Effects of Health Care Reform: Medicaid Expansion under the Affordable Care Act and changes in Volunteering

Science.gov (United States)

Sohn, Heeju; Timmermans, Stefan

2017-01-01

Do public health policy interventions result in pro-social behaviors? The Affordable Care Act (ACA)’s Medicaid expansions were responsible for the largest gains in public insurance coverage since its inception in 1965. These gains were concentrated in states that opted to expand Medicaid eligibility and provide a unique opportunity to study not just medical but also social consequences of increased public health coverage. This article examines the association between Medicaid and volunteer work. Volunteerism is implicated in individuals’ health and well-being yet it is highly correlated with a person’s existing socioeconomic resources. Medicaid expansions improved financial security and a sense of health—two factors that predict volunteer work—for a socioeconomic group that has had low levels of volunteerism. Difference-in-difference analyses of the Volunteer Supplement of the Current Population Survey (2010–2015) find increased reports of formal volunteering for organizations as well as informal helping behaviors between neighbors for low-income non-elderly adults who would have likely benefited from expansions. Furthermore, increased volunteer work associated with Medicaid was greater among minority groups and narrowed existing ethnic differences in volunteerism in states that expanded Medicaid eligibility. PMID:29142907

Prescription Drugs: Comparison of DOD, Medicaid, and Medicare Part D Retail Reimbursement Prices

Science.gov (United States)

2014-06-01

information, including suggestions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215...Medicaid Services DIR direct and indirect remuneration DOD Department of Defense FCP federal ceiling price HCPCS Healthcare Common Procedure...prices, we used PDTS data from DOD; unit rebate amount (URA) and CMS-64 data from Medicaid; and the 2010 Direct and Indirect Remuneration (DIR

Development of Core Competencies for Paraprofessional Nutrition Educators Who Deliver Food Stamp Nutrition Education

Science.gov (United States)

Baker, Susan S.; Pearson, Meredith; Chipman, Helen

2009-01-01

The purpose of this project was to describe the process used for the development of core competencies for paraprofessional nutrition educators in Food Stamp Nutrition Education (FSNE). The development process included the efforts of an expert panel of state and multicounty FSNE leaders to draft the core competencies and the validation of those…

Clinicians' awareness of the Affordable Care Act mandate to provide comprehensive tobacco cessation treatment for pregnant women covered by Medicaid

Directory of Open Access Journals (Sweden)

Van T. Tong

2015-01-01

Full Text Available The Affordable Care Act (ACA requires states to provide tobacco-cessation services without cost-sharing for pregnant traditional Medicaid-beneficiaries effective October 2010. It is unknown the extent to which obstetricians–gynecologists are aware of the Medicaid tobacco-cessation benefit. We sought to examine the awareness of the Medicaid tobacco-cessation benefit in a national sample of obstetricians–gynecologists and assessed whether reimbursement would influence their tobacco cessation practice. In 2012, a survey was administered to a national stratified-random sample of obstetricians–gynecologists (n = 252 regarding awareness of the Medicaid tobacco-cessation benefit. Results were stratified by the percentage of pregnant Medicaid patients. Chi-squared tests (p < 0.05 were used to assess significant associations. Analyses were conducted in 2014. Eighty-three percent of respondents were unaware of the benefit. Lack of awareness increased as the percentage of pregnant Medicaid patients in their practices decreased (range = 71.9%–96.8%; P = 0.02. One-third (36.1% of respondents serving pregnant Medicaid patients reported that reimbursement would influence them to increase their cessation services. Four out of five obstetricians–gynecologists surveyed in 2012 were unaware of the ACA provision that required states to provide tobacco cessation coverage for pregnant traditional Medicaid beneficiaries as of October 2010. Broad promotion of the Medicaid tobacco-cessation benefit could reduce treatment barriers.

Poor oral health as an obstacle to employment for Medicaid beneficiaries with disabilities.

Science.gov (United States)

Hall, Jean P; Chapman, Shawna L Carroll; Kurth, Noelle K

2013-01-01

To inform policy with better information about the oral health-care needs of a Medicaid population that engages in employment, that is, people ages 16 to 64 with Social Security-determined disabilities enrolled in a Medicaid Buy-In program. Statistically test for significant differences among responses to a Medicaid Buy-In program satisfaction survey that included oral health questions from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System and the Oral Health Impact Profile (OHIP) to results for the state's general population and the US general population. All measures of dental care access and oral health were significantly worse for the study population as compared with a state general population or a US general population. Differences were particularly pronounced for the OHIP measure for difficulty doing one's job due to dental problems, which was almost five times higher for the study population. More comprehensive dental benefits for the study population could result in increased oral and overall health, and eventual cost savings to Medicaid as more people work, have improved health, and pay premiums for coverage. © 2012 American Association of Public Health Dentistry.

An evaluation of the impact of maternity care coordination on Medicaid birth outcomes in North Carolina.

Science.gov (United States)

Buescher, P A; Roth, M S; Williams, D; Goforth, C M

1991-12-01

Care coordination is an important component of the enhanced prenatal care services provided under the recent expansions of the Medicaid program. The effect of maternity care coordination services on birth outcomes in North Carolina was assessed by comparing women on Medicaid who did and did not receive these services. Health program data files, including Medicaid claims paid for maternity care coordination, were linked to 1988 and 1989 live birth certificates. Simple comparisons of percentages and rates were supplemented by a logistic regression analysis. Among women on Medicaid who did not receive maternity care coordination services, the low birth weight rate was 21% higher, the very low birth weight rate was 62% higher, and the infant mortality rate was 23% higher than among women on Medicaid who did receive such services. It was estimated that, for each $1.00 spent on maternity care coordination, Medicaid saved $2.02 in medical costs for newborns up to 60 days of age. Among the women who did receive maternity care coordination, those receiving it for 3 or more months had better outcomes than those receiving it for less than 3 months. These results suggest that maternity care coordination can be effective in reducing low birth weight, infant mortality, and newborn medical care costs among babies born to women in poverty.

Medicaid Coverage of Methadone Maintenance and the Use of Opioid Agonist Therapy Among Pregnant Women in Specialty Treatment.

Science.gov (United States)

Bachhuber, Marcus A; Mehta, Pooja K; Faherty, Laura J; Saloner, Brendan

2017-12-01

Opioid agonist therapy (OAT) is the standard of care for pregnant women with opioid use disorder (OUD). Medicaid coverage policies may strongly influence OAT use in this group. To examine the association between Medicaid coverage of methadone maintenance and planned use of OAT in the publicly funded treatment system. Retrospective cross-sectional analysis of treatment admissions in 30 states extracted from the Treatment Episode Data Set (2013 and 2014). Medicaid-insured pregnant women with OUD (n=3354 treatment admissions). The main outcome measure was planned use of OAT on admission. The main exposure was state Medicaid coverage of methadone maintenance. Using multivariable logistic regression models adjusting for sociodemographic, substance use, and treatment characteristics, we compared the probability of planned OAT use in states with Medicaid coverage of methadone maintenance versus states without coverage. A total of 71% of pregnant women admitted to OUD treatment were 18-29 years old, 85% were white non-Hispanic, and 56% used heroin. Overall, 74% of admissions occurred in the 18 states with Medicaid coverage of methadone maintenance and 53% of admissions involved planned use of OAT. Compared with states without Medicaid coverage of methadone maintenance, admissions in states with coverage were significantly more likely to involve planned OAT use (adjusted difference: 32.9 percentage points, 95% confidence interval, 19.2-46.7). Including methadone maintenance in the Medicaid benefit is essential to increasing OAT among pregnant women with OUD and should be considered a key policy strategy to enhance outcomes for mothers and newborns.

Medicaid Coverage Of Cessation Treatments And Barriers To Treatments

Data.gov (United States)

U.S. Department of Health & Human Services — 2008-2018. American Lung Association. Cessation Coverage. Medicaid data compiled by the Centers for Disease Control and Prevention’s Office on Smoking and Health...

Center for Medicare & Medicaid Services (CMS) , Medicare Claims data

Data.gov (United States)

U.S. Department of Health & Human Services — 2003 forward. CMS compiles claims data for Medicare and Medicaid patients across a variety of categories and years. This includes Inpatient and Outpatient claims,...

Microstructure, Mechanical Properties, and Toughening Mechanisms of a New Hot Stamping-Bake Toughening Steel

Science.gov (United States)

Lin, Tao; Song, Hong-Wu; Zhang, Shi-Hong; Cheng, Ming; Liu, Wei-Jie; Chen, Yun

2015-09-01

In this article, the hot stamping-bake toughening process has been proposed following the well-known concept of bake hardening. The influences of the bake time on the microstructure and the mechanical properties of the hot stamped-baked part were studied by means of scanning electron microscopy, transmission electron microscopy, X-ray diffraction, and mechanical tests at room temperature. The results show that the amount of the retained austenite was nearly not changed by the bake process. Also observed were spherical Cu-rich precipitates of about 15 nm in martensite laths. According to the Orowan mechanism, their contribution of the Cu-rich precipitates to the strength is approximately 245 MPa. With the increase of the bake time, the tensile strength of the part was decreased, whereas both the ductility and the product of the tensile strength and ductility were increased then decreased. The tensile strength and ductility product and the tensile strength are as high as 21.9 GPa pct, 2086 MPa, respectively. The excellent combined properties are due to the transformation-induced plasticity effect caused by retained austenite.

Determination of stamp deformation during imprinting on semi-spherical surfaces

DEFF Research Database (Denmark)

Kafka, Jan; Matschuk, Maria; Pranov, Henrik

of sol-gel was applied onto spherical injection mold inserts and subsequently imprinted using a flexible stamp. A hard curing step transformed the sol-gel into a quartz-like and durable material. As an example, we present theory and results regarding the imprint of pillar nanostructures on semi......-spherical mold surfaces. Imprints were realized on three different radii of circumferenceof the spherical mold: R = 0.5 mm, R = 1.0 mm, and R = 2 mm. After hard-curing of theimprinted sol-gel, the inserts were used for cold-mold as well as vario-therm injection molding.The polymer replicas and the inserts were...

Medicaid program choice, inertia and adverse selection.

Science.gov (United States)

Marton, James; Yelowitz, Aaron; Talbert, Jeffery C

2017-12-01

In 2012, Kentucky implemented Medicaid managed care statewide, auto-assigned enrollees to three plans, and allowed switching. Using administrative data, we find that the state's auto-assignment algorithm most heavily weighted cost-minimization and plan balancing, and placed little weight on the quality of the enrollee-plan match. Immobility - apparently driven by health plan inertia - contributed to the success of the cost-minimization strategy, as more than half of enrollees auto-assigned to even the lowest quality plans did not opt-out. High-cost enrollees were more likely to opt-out of their auto-assigned plan, creating adverse selection. The plan with arguably the highest quality incurred the largest initial profit margin reduction due to adverse selection prior to risk adjustment, as it attracted a disproportionate share of high-cost enrollees. The presence of such selection, caused by differential degrees of mobility, raises concerns about the long run viability of the Medicaid managed care market without such risk adjustment. Copyright © 2017 Elsevier B.V. All rights reserved.

The evolving role and care management approaches of safety-net Medicaid managed care plans.

Science.gov (United States)

Gusmano, Michael K; Sparer, Michael S; Brown, Lawrence D; Rowe, Catherine; Gray, Bradford

2002-12-01

This article provides new empirical data about the viability and the care management activities of Medicaid managed-care plans sponsored by provider organizations that serve Medicaid and other low-income populations. Using survey and case study methods, we studied these "safety-net" health plans in 1998 and 2000. Although the number of safety-net plans declined over this period, the surviving plans were larger and enjoying greater financial success than the plans we surveyed in 1998. We also found that, based on a partnership with providers, safety-net plans are moving toward more sophisticated efforts to manage the care of their enrollees. Our study suggests that, with supportive state policies, safety-net plans are capable of remaining viable. Contracting with safety-net plans may not be an efficient mechanism for enabling Medicaid recipients to "enter the mainstream of American health care," but it may provide states with an effective way to manage and coordinate the care of Medicaid recipients, while helping to maintain the health care safety-net for the uninsured.

Fabrication of Glass Microchannel via Glass Imprinting using a Vitreous Carbon Stamp for Flow Focusing Droplet Generator

Science.gov (United States)

Refatul Haq, Muhammad; Kim, Youngkyu; Kim, Jun; Oh, Pyoung-hwa; Ju, Jonghyun; Kim, Seok-Min; Lim, Jiseok

2017-01-01

This study reports a cost-effective method of replicating glass microfluidic chips using a vitreous carbon (VC) stamp. A glass replica with the required microfluidic microstructures was synthesized without etching. The replication method uses a VC stamp fabricated by combining thermal replication using a furan-based, thermally-curable polymer with carbonization. To test the feasibility of this method, a flow focusing droplet generator with flow-focusing and channel widths of 50 µm and 100 µm, respectively, was successfully fabricated in a soda-lime glass substrate. Deviation between the geometries of the initial shape and the vitreous carbon mold occurred because of shrinkage during the carbonization process, however this effect could be predicted and compensated for. Finally, the monodispersity of the droplets generated by the fabricated microfluidic device was evaluated. PMID:29286341

Fabrication of Glass Microchannel via Glass Imprinting using a Vitreous Carbon Stamp for Flow Focusing Droplet Generator

Directory of Open Access Journals (Sweden)

Hyungjun Jang

2017-12-01

Full Text Available This study reports a cost-effective method of replicating glass microfluidic chips using a vitreous carbon (VC stamp. A glass replica with the required microfluidic microstructures was synthesized without etching. The replication method uses a VC stamp fabricated by combining thermal replication using a furan-based, thermally-curable polymer with carbonization. To test the feasibility of this method, a flow focusing droplet generator with flow-focusing and channel widths of 50 µm and 100 µm, respectively, was successfully fabricated in a soda-lime glass substrate. Deviation between the geometries of the initial shape and the vitreous carbon mold occurred because of shrinkage during the carbonization process, however this effect could be predicted and compensated for. Finally, the monodispersity of the droplets generated by the fabricated microfluidic device was evaluated.

Florida's model of nursing home Medicaid reimbursement for disaster-related expenses.

Science.gov (United States)

Thomas, Kali S; Hyer, Kathryn; Brown, Lisa M; Polivka-West, LuMarie; Branch, Laurence G

2010-04-01

This study describes Florida's model of Medicaid nursing home (NH) reimbursement to compensate NHs for disaster-related expenses incurred as a result of 8 hurricanes within a 2-year period. This Florida model can serve as a demonstration for a national model for disaster-related reimbursement. Florida reimburses NHs for approved disaster-related costs through hurricane interim rate requests (IRRs). The state developed its unique Medicaid per diem rate temporary add-on by adapting its standard rate-setting reimbursement methodology. To understand the payment mechanisms and the costs that facilities incurred as a result of natural disasters, we examined the IRRs and cost reports for facilities requesting and receiving reimbursement. Cost reports and IRR applications indicated that Florida Medicaid spent close to $16 million to pay for hurricane-related costs to NHs. Without Florida's Hurricane IRR program, many facilities would have not been reimbursed for their hurricane-related costs. Florida's model is one that Medicare and other states should consider adopting to ensure that NHs receive adequate reimbursement for disaster-related expenses, including tornadoes, earthquakes, floods, blizzards, and other catastrophic events.

How Medicaid and Other Public Policies Affect Use of Tobacco Cessation Therapy, United States, 2010–2014

Science.gov (United States)

Brantley, Erin; Bysshe, Tyler; Steinmetz, Erika; Bruen, Brian K.

2016-01-01

Introduction State Medicaid programs can cover tobacco cessation therapies for millions of low-income smokers in the United States, but use of this benefit is low and varies widely by state. This article assesses the effects of changes in Medicaid benefit policies, general tobacco policies, smoking norms, and public health programs on the use of cessation therapy among Medicaid smokers. Methods We used longitudinal panel analysis, using 2-way fixed effects models, to examine the effects of changes in state policies and characteristics on state-level use of Medicaid tobacco cessation medications from 2010 through 2014. Results Medicaid policies that require patients to obtain counseling to get medications reduced the use of cessation medications by approximately one-quarter to one-third; states that cover all types of cessation medications increased usage by approximately one-quarter to one-third. Non-Medicaid policies did not have significant effects on use levels. Conclusions States could increase efforts to quit by developing more comprehensive coverage and reducing barriers to coverage. Reductions in barriers could bolster smoking cessation rates, and the costs would be small compared with the costs of treating smoking-related diseases. Innovative initiatives to help smokers quit could improve health and reduce health care costs. PMID:27788063

Stamping SERS for creatinine sensing

Science.gov (United States)

Li, Ming; Du, Yong; Zhao, Fusheng; Zeng, Jianbo; Santos, Greggy M.; Mohan, Chandra; Shih, Wei-Chuan

2015-03-01

Urine can be obtained easily, readily and non-invasively. The analysis of urine can provide metabolic information of the body and the condition of renal function. Creatinine is one of the major components of human urine associated with muscle metabolism. Since the content of creatinine excreted into urine is relatively constant, it is used as an internal standard to normalize water variations. Moreover, the detection of creatinine concentration in urine is important for the renal clearance test, which can monitor the filtration function of kidney and health status. In more details, kidney failure can be imminent when the creatinine concentration in urine is high. A simple device and protocol for creatinine sensing in urine samples can be valuable for point-of-care applications. We reported quantitative analysis of creatinine in urine samples by using stamping surface enhanced Raman scattering (S-SERS) technique with nanoporous gold disk (NPGD) based SERS substrate. S-SERS technique enables label-free and multiplexed molecular sensing under dry condition, while NPGD provides a robust, controllable, and high-sensitivity SERS substrate. The performance of S-SERS with NGPDs is evaluated by the detection and quantification of pure creatinine and creatinine in artificial urine within physiologically relevant concentration ranges.

45 CFR 303.11 - Case closure criteria.

Science.gov (United States)

2010-10-01

... Federal government or a company with headquarters or offices in the United States, and has no reachable...) There has been a finding by the responsible State agency of good cause or other exceptions to cooperation with the IV-D agency and the State or local IV-A, IV-D, IV-E, Medicaid or food stamp agency has...

Prenatal Care: Medicaid Recipients and Uninsured Women Obtain Insufficient Care. Report to the Chairman, Subcommittee on Human Resources and Intergovernmental Relations, Committee on Government Operations, House of Representatives.

Science.gov (United States)

General Accounting Office, Washington, DC. Div. of Human Resources.

Women who had no health insurance or who were enrolled in Medicaid were interviewed to determine the extent of their prenatal care. Those most likely to obtain insufficient care were the women who were uninsured, poorly educated, Black or Hispanic, or teenagers from large urban areas. Barriers to earlier or more frequent prenatal care were the…

The relationship of California's Medicaid reimbursement system to nurse staffing levels.

Science.gov (United States)

Mukamel, Dana B; Kang, Taewoon; Collier, Eric; Harrington, Charlene

2012-10-01

Policy initiatives at the Federal and state level are aimed at increasing staffing in nursing homes. These include direct staffing standards, public reporting, and financial incentives. To examine the impact of California's Medicaid reimbursement for nursing homes which includes incentives directed at staffing. Two-stage limited-information maximum-likelihood regressions were used to model the relationship between staffing [registered nurses (RNs), licensed practical nurses, and certified nursing assistants hours per resident day] and the Medicaid payment rate, accounting for the specific structure of the payment system, endogeneity of payment and case-mix, and controlling for facility and market characteristics. A total of 927 California free-standing nursing homes in 2006. The model included facility characteristics (case-mix, size, ownership, and chain affiliation), market competition and excess demand, labor supply and wages, unemployment, and female employment. The instrumental variable for Medicaid reimbursement was the peer group payment rate for 7 geographical market areas, and the instrumental variables for resident case-mix were the average county revenues for professional therapy establishments and the percent of county population aged 65 and over. Consistent with the rate incentives and rational expectation behavior, expected nursing home reimbursement rates in 2008 were associated with increased RN staffing levels in 2006 but had no relationship with licensed practical nurse and certified nursing assistant staffing. The effect was estimated at 2 minutes per $10 increase in rate. The incentives in the Medicaid system impacted only RN staffing suggesting the need to improve the state's rate setting methodology.

Human factors science and safety engineering : can the STAMP model serve in establishing a common language?

NARCIS (Netherlands)

Karanikas, Nektarios; Schwarz, M; Harfmann, J

2017-01-01

A symbiotic relationship between human factors and safety scientists is needed to ensure the provision of holistic solutions for problems emerging in modern socio-technical systems. System Theoretic Accident Model and Processes (STAMP) tackles both interactions and individual failures of human and

Comparing the Medicaid Retrospective Drug Utilization Review Program Cost-Savings Methods Used by State Agencies.

Science.gov (United States)

Prada, Sergio I

2017-12-01

The Medicaid Drug Utilization Review (DUR) program is a 2-phase process conducted by Medicaid state agencies. The first phase is a prospective DUR and involves electronically monitoring prescription drug claims to identify prescription-related problems, such as therapeutic duplication, contraindications, incorrect dosage, or duration of treatment. The second phase is a retrospective DUR and involves ongoing and periodic examinations of claims data to identify patterns of fraud, abuse, underutilization, drug-drug interaction, or medically unnecessary care, implementing corrective actions when needed. The Centers for Medicare & Medicaid Services requires each state to measure prescription drug cost-savings generated from its DUR programs on an annual basis, but it provides no guidance or unified methodology for doing so. To describe and synthesize the methodologies used by states to measure cost-savings using their Medicaid retrospective DUR program in federal fiscal years 2014 and 2015. For each state, the cost-savings methodologies included in the Medicaid DUR 2014 and 2015 reports were downloaded from Medicaid's website. The reports were then reviewed and synthesized. Methods described by the states were classified according to research designs often described in evaluation textbooks. In 2014, the most often used prescription drugs cost-savings estimation methodology for the Medicaid retrospective DUR program was a simple pre-post intervention method, without a comparison group (ie, 12 states). In 2015, the most common methodology used was a pre-post intervention method, with a comparison group (ie, 14 states). Comparisons of savings attributed to the program among states are still unreliable, because of a lack of a common methodology available for measuring cost-savings. There is great variation among states in the methods used to measure prescription drug utilization cost-savings. This analysis suggests that there is still room for improvement in terms of

Comparing the Affordable Care Act's Financial Impact on Safety-Net Hospitals in States That Expanded Medicaid and Those That Did Not.

Science.gov (United States)

Dobson, Allen; DaVanzo, Joan E; Haught, Randy; Phap-Hoa, Luu

2017-11-01

Safety-net hospitals play a vital role in delivering health care to Medicaid enrollees, the uninsured, and other vulnerable patients. By reducing the number of uninsured Americans, the Affordable Care Act (ACA) was also expected to lower these hospitals’ significant uncompensated care costs and shore up their financial stability. To examine how the ACA’s Medicaid expansion affected the financial status of safety-net hospitals in states that expanded Medicaid and in states that did not. Using Medicare hospital cost reports for federal fiscal years 2012 and 2015, the authors compared changes in Medicaid inpatient days as a percentage of total inpatient days, Medicaid revenues as a percentage of total net patient revenues, uncompensated care costs as a percentage of total operating costs, and hospital operating margins. Medicaid expansion had a significant, favorable financial impact on safety-net hospitals. From 2012 to 2015, safety-net hospitals in expansion states, compared to those in nonexpansion states, experienced larger increases in Medicaid inpatient days and Medicaid revenues as well as reduced uncompensated care costs. These changes improved operating margins for safety-net hospitals in expansion states. Margins for safety-net hospitals in nonexpansion states, meanwhile, declined.

Increased Use of Dental Services by Children in Medicaid

Data.gov (United States)

U.S. Department of Health & Human Services — This report analyzes the use of dental services by children enrolled in Medicaid from federal fiscal years (FFY) 2000 to 2010. The number and percent of children...

Medicaid Coverage Of Cessation Treatments And Barriers To Treatments

Data.gov (United States)

U.S. Department of Health & Human Services — 2008-2016. American Lung Association. Cessation Coverage. Medicaid data compiled by the Centers for Disease Control and Prevention’s Office on Smoking and Health...

State Medicaid Expansions for Parents Led to Increased Coverage and Prenatal Care Utilization among Pregnant Mothers.

Science.gov (United States)

Wherry, Laura R

2017-12-28

To evaluate impacts of state Medicaid expansions for low-income parents on the health insurance coverage, pregnancy intention, and use of prenatal care among mothers who became pregnant. Person-level data for women with a live birth from the 1997-2012 Pregnancy Risk Assessment Monitoring System. The sample was restricted to women who were already parents using information on previous live births and combined with information on state Medicaid policies for low-income parents. I used a measure of expanded generosity of state Medicaid eligibility for low-income parents to estimate changes in health insurance, pregnancy intention, and prenatal care for pregnant mothers associated with Medicaid expansion. I found an increase in prepregnancy health insurance coverage and coverage during pregnancy among pregnant mothers, as well as earlier initiation of prenatal care, associated with the expansions. Among pregnant mothers with less education, I found an increase in the adequacy of prenatal care utilization. Expanded Medicaid coverage for low-income adults has the potential to increase a woman's health insurance coverage prior to pregnancy, as well as her insurance coverage and medical care receipt during pregnancy. © Health Research and Educational Trust.

The Expanding Role of Managed Care in the Medicaid Program

Science.gov (United States)

Caswell, Kyle J.; Long, Sharon K.

2015-01-01

States increasingly use managed care for Medicaid enrollees, yet evidence of its impact on health care outcomes is mixed. This research studies county-level Medicaid managed care (MMC) penetration and health care outcomes among nonelderly disabled and nondisabled enrollees. Results for nondisabled adults show that increased penetration is associated with increased probability of an emergency department visit, difficulty seeing a specialist, and unmet need for prescription drugs, and is not associated with reduced expenditures. We find no association between penetration and health care outcomes for disabled adults. This suggests that the primary gains from MMC may be administrative simplicity and budget predictability for states rather than reduced expenditures or improved access for individuals. PMID:25882616

Psychotropic Medication Trends among Children and Adolescents with Autism Spectrum Disorder in the Medicaid Program

Science.gov (United States)

Schubart, Jane R.; Camacho, Fabian; Leslie, Douglas

2014-01-01

This study characterized psychotropic medication use among Medicaid-enrolled children and adolescents with autism spectrum disorders by examining trends over time, including length of treatment and polypharmacy using 4 years of administrative claims data from 41 state Medicaid programs (2000-2003). The data set included nearly 3 million children…

Medicaid program; health care-related taxes. Final rule.

Science.gov (United States)

2009-06-30

This rule finalizes our proposal to delay enforcement of certain clarifications regarding standards for determining hold harmless arrangements in the final rule entitled, "Medicaid Program; Health Care-Related Taxes" from the expiration of a Congressional moratorium on enforcement from July 1, 2009 to June 30, 2010.

Increased Use of Dental Services by Children Covered by Medicaid: 2000–2010

Science.gov (United States)

Ku, Leighton; Sharac, Jessica; Bruen, Brian; Thomas, Megan; Norris, Laurie

2013-01-01

This report analyzes the use of dental services by children enrolled in Medicaid from federal fiscal years (FFY) 2000 to 2010. The number and percent of children receiving dental services under Medicaid climbed continuously over the decade. In FFY 2000, 6.3 million children ages 1 to 20 were reported to receive some form of dental care (either preventive or treatment); the number more than doubled to 15.4 million by FFY 2010. Part of the increase was because the overall number of children covered by Medicaid rose by 12 million (50%), but the percentage of children who received dental care climbed appreciably from 29.3% in FFY 2000 to 46.4% in FFY 2010. In that same time period, the number of children ages 1 to 20 receiving preventive dental services climbed from a reported 5.0 million to 13.6 million, while the percentage of children receiving preventive dental services rose from 23.2% to 40.8%. For children ages 1 to 20 who received dental treatment services, the reported number rose from 3.3 million in FFY 2000 to 7.6 million in FFY 2010. The percentage of children who obtained dental treatment services increased from 15.3% to 22.9%. In FFY 2010, about one sixth of children covered by Medicaid (15.7%) ages 6-14 had a dental sealant placed on a permanent molar. While most states have made steady progress in improving children's access to dental care in Medicaid over the past decade, there is still substantial variation across states and more remains to be done. PMID:24753975

Time stamp generation with inverse FIR filters for Positron Emission Tomography

International Nuclear Information System (INIS)

Namias, Mauro

2009-01-01

Photon coincidence detection is the process by which Positron Emission Tomography (PET) works. This requires the determination of the time of impact of each coincident photon at the detector system, also known as time stamp. In this work, the timestamp was generated by means of digital time-domain deconvolution with FIR filters for a INa(Tl) based system. The detector deadtime was reduced from 350 ns to 175 ns while preserving the system's energy resolution and a direct relation between the amount of light collected and the temporal resolution was found.(author)

Attenuated Total Reflection Fourier Transform Infrared (ATR FT-IR) Spectroscopy as a Forensic Method to Determine the Composition of Inks Used to Print the United States One-cent Blue Benjamin Franklin Postage Stamps of the 19th Century.

Science.gov (United States)

Brittain, Harry G

2016-01-01

Through the combined use of infrared (IR) absorption spectroscopy and attenuated total reflectance (ATR) sampling, the composition of inks used to print the many different types of one-cent Benjamin Franklin stamps of the 19th century has been established. This information permits a historical evaluation of the formulations used at various times, and also facilitates the differentiation of the various stamps from each other. In two instances, the ink composition permits the unambiguous identification of stamps whose appearance is identical, and which (until now) have only been differentiated through estimates of the degree of hardness or softness of the stamp paper, or through the presence or absence of a watermark in the paper. In these instances, the use of ATR Fourier transform infrared spectroscopy (FT-IR) spectroscopy effectively renders irrelevant two 100-year-old practices of stamp identification. Furthermore, since the use of ATR sampling makes it possible to obtain the spectrum of a stamp still attached to its cover, it is no longer necessary to identify these blue Franklin stamps using their cancellation dates. © The Author(s) 2015.

Rethinking Medicaid Coverage and Payment Policy to Promote High Value Care: The Case of Long-Acting Reversible Contraception.

Science.gov (United States)

Vela, Veronica X; Patton, Elizabeth W; Sanghavi, Darshak; Wood, Susan F; Shin, Peter; Rosenbaum, Sara

Long-acting reversible contraception (LARC) is the most effective reversible method to prevent unplanned pregnancies. Variability in state-level policies and the high cost of LARC could create substantial inconsistencies in Medicaid coverage, despite federal guidance aimed at enhancing broad access. This study surveyed state Medicaid payment policies and outreach activities related to LARC to explore the scope of services covered. Using publicly available information, we performed a content analysis of state Medicaid family planning and LARC payment policies. Purposeful sampling led to a selection of nine states with diverse geographic locations, political climates, Medicaid expansion status, and the number of women covered by Medicaid. All nine states' Medicaid programs covered some aspects of LARC. However, only a single state's payment structure incorporated all core aspects of high-quality LARC service delivery, including counseling, device, insertion, removal, and follow-up care. Most states did not explicitly address counseling, device removal, or follow-up care. Some states had strategies to enhance access, including policies to increase device reimbursement, stocking and delivery programs to remove cost barriers, and covering devices and insertion after an abortion. Although Medicaid policy encourages LARC methods, state payment policies frequently fail to address key aspects of care, including counseling, follow-up care, and removal, resulting in highly variable state-level practices. Although some states include payment policy innovations to support LARC access, significant opportunities remain. Published by Elsevier Inc.

Saving Teens: Using a Policy Discontinuity to Estimate the Effects of Medicaid Eligibility

OpenAIRE

Bruce D. Meyer; Laura R. Wherry

2012-01-01

This paper uses a policy discontinuity to identify the immediate and long-term effects of public health insurance coverage during childhood. Our identification strategy exploits a unique feature of several early Medicaid expansions that extended eligibility only to children born after September 30, 1983. This feature resulted in a large discontinuity in the lifetime years of Medicaid eligibility of children at this birthdate cutoff. Those with family incomes at or just below the poverty line ...

All-silica nanofluidic devices for DNA-analysis fabricated by imprint of sol-gel silica with silicon stamp

DEFF Research Database (Denmark)

Mikkelsen, Morten Bo Lindholm; Letailleur, Alban A; Søndergård, Elin

2011-01-01

We present a simple and cheap method for fabrication of silica nanofluidic devices for single-molecule studies. By imprinting sol-gel materials with a multi-level stamp comprising micro- and nanofeatures, channels of different depth are produced in a single process step. Calcination of the imprin......We present a simple and cheap method for fabrication of silica nanofluidic devices for single-molecule studies. By imprinting sol-gel materials with a multi-level stamp comprising micro- and nanofeatures, channels of different depth are produced in a single process step. Calcination...... of the imprinted hybrid sol-gel material produces purely inorganic silica, which has very low autofluorescence and can be fusion bonded to a glass lid. Compared to top-down processing of fused silica or silicon substrates, imprint of sol-gel silica enables fabrication of high-quality nanofluidic devices without...

More Rhode Island Adults Have Dental Coverage After the Medicaid Expansion: Did More Adults Receive Dental Services? Did More Dentists Provide Services?

Science.gov (United States)

Zwetchkenbaum, Samuel; Oh, Junhie

2017-10-02

Under the Affordable Care Act (ACA) Medicaid expansion since 2014, 68,000 more adults under age 65 years were enrolled in Rhode Island Medicaid as of December 2015, a 78% increase from 2013 enrollment. This report assesses changes in dental utilization associated with this expansion. Medicaid enrollment and dental claims for calendar years 2012-2015 were extracted from the RI Medicaid Management Information System. Among adults aged 18-64 years, annual numbers and percentages of Medicaid enrollees who received any dental service were summarized. Additionally, dental service claims were assessed by provider type (private practice or health center). Although 15,000 more adults utilized dental services by the end of 2015, the annual percentage of Medicaid enrollees who received any dental services decreased over the reporting periods, compared to pre-ACA years (2012-13: 39%, 2014: 35%, 2015: 32%). From 2012 to 2015, dental patient increases in community health centers were larger than in private dental offices (78% vs. 34%). Contrary to the Medicaid population increase, the number of dentists that submitted Medicaid claims decreased, particularly among dentists in private dental offices; the percentage of RI private dentists who provided any dental service to adult Medicaid enrollees decreased from 29% in 2012 to 21% in 2015. Implementation of Medicaid expansion has played a critical role in increasing the number of Rhode Islanders with dental coverage, particularly among low-income adults under age 65. However, policymakers must address the persistent and worsening shortage of dental providers that accept Medicaid to provide a more accessible source of oral healthcare for all Rhode Islanders. [Full article available at http://rimed.org/rimedicaljournal-2017-10.asp].

Small-area Variation in Hypertension Prevalence among Black and White Medicaid Enrollees.

Science.gov (United States)

White, Kellee; Stewart, John E; Lòpez-DeFede, Ana; Wilkerson, Rebecca C

2016-07-21

To examine within-state geographic heterogeneity in hypertension prevalence and evaluate associations between hypertension prevalence and small-area contextual characteristics for Black and White South Carolina Medicaid enrollees in urban vs rural areas. Ecological. South Carolina, United States. Hypertension prevalence. Data representing adult South Carolina Medicaid recipients enrolled in fiscal year 2013 (N=409,907) and ZIP Code Tabulation Area (ZCTA)-level contextual measures (racial segregation, rurality, poverty, educational attainment, unemployment and primary care physician adequacy) were linked in a spatially referenced database. Optimized Getis-Ord hotspot mapping was used to visualize geographic clustering of hypertension prevalence. Spatial regression was performed to examine the association between hypertension prevalence and small-area contextual indicators. Significant (alpha=.05) hotspot spatial clustering patterns were similar for Blacks and Whites. Black isolation was significantly associated with hypertension among Blacks and Whites in both urban (Black, b=1.34, P<.01; White, b=.66, P<.01) and rural settings (Black, b=.71, P=.02; White, b=.70, P<.01). Primary care physician adequacy was associated with hypertension among urban Blacks (b=-2.14, P<.01) and Whites (b=-1.74, P<.01). The significant geographic overlap of hypertension prevalence hotspots for Black and White Medicaid enrollees provides an opportunity for targeted health intervention. Provider adequacy findings suggest the value of ACA network adequacy standards for Medicaid managed care plans in ensuring health care accessibility for persons with hypertension and related chronic conditions.

Medicaid payment rates, case-mix reimbursement, and nursing home staffing--1996-2004.

Science.gov (United States)

Feng, Zhanlian; Grabowski, David C; Intrator, Orna; Zinn, Jacqueline; Mor, Vincent

2008-01-01

We examined the impact of state Medicaid payment rates and case-mix reimbursement on direct care staffing levels in US nursing homes. We used a recent time series of national nursing home data from the Online Survey Certification and Reporting system for 1996-2004, merged with annual state Medicaid payment rates and case-mix reimbursement information. A 5-category response measure of total staffing levels was defined according to expert recommended thresholds, and examined in a multinomial logistic regression model. Facility fixed-effects models were estimated separately for Registered Nurse (RN), Licensed Practical Nurse (LPN), and Certified Nurse Aide (CNA) staffing levels measured as average hours per resident day. Higher Medicaid payment rates were associated with increases in total staffing levels to meet a higher recommended threshold. However, these gains in overall staffing were accompanied by a reduction of RN staffing and an increase in both LPN and CNA staffing levels. Under case-mix reimbursement, the likelihood of nursing homes achieving higher recommended staffing thresholds decreased, as did levels of professional staffing. Independent of the effects of state, market, and facility characteristics, there was a significant downward trend in RN staffing and an upward trend in both LPN and CNA staffing. Although overall staffing may increase in response to more generous Medicaid reimbursement, it may not translate into improvements in the skill mix of staff. Adjusting for reimbursement levels and resident acuity, total staffing has not increased after the implementation of case-mix reimbursement.

Analysis Of Die Design For The Stamping Of A Bathtub

Directory of Open Access Journals (Sweden)

Hojny M.

2015-06-01

Full Text Available The paper presents example results of numerical and photogrammetric analysis leading to identify the causes of cracking and wrinkling during bathtub W1200 production. The verification of tools for the stamping of bathtub W1200 was performed using finite element method and photogrammetric system ATOS Triple Scan. A series of industrial tests was conducted to identify the model parameters. The major and minor strain distributions obtained from the finite element simulations were used in conjunction with the forming limit diagram to predict the onset of fracture. In addition, the effects of blank holder pressure and friction on the occurrence of fracture and wrinkling were investigated.

An interactive and flexible approach to stamping design and optimization

International Nuclear Information System (INIS)

Roy, Subir; Kunju, Ravi; Kirby, David

2004-01-01

This paper describes an efficient method that integrates finite element analysis (FEA), mesh morphing and response surface based optimization in order to implement an automated and flexible software tool to optimize stamping tool and process design. For FEA, a robust and extremely fast inverse solver is chosen. For morphing, a state of the art mesh morpher that interactively generates shape variables for optimization studies is used. The optimization algorithm utilized in this study enables a global search for a multitude of parameters and is highly flexible with regards to the choice of objective functions. A quality function that minimizes formability defects resulting from stretching and compression is implemented

Service Use in the Month and Year Prior to Suicide Among Adults Enrolled in Ohio Medicaid.

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Fontanella, Cynthia A; Warner, Lynn A; Hiance-Steelesmith, Danielle L; Sweeney, Helen Anne; Bridge, Jeffrey A; McKeon, Richard; Campo, John V

2017-07-01

The purpose of this study was to inform suicide prevention efforts by estimating the incidence of suicide among adult Medicaid enrollees and describing clinical profiles and service utilization patterns among decedents. Death certificate data for adults (N=1,338) ages 19 to 65 who died by suicide between January 1, 2008, and December 31, 2013, were linked with Ohio Medicaid data. The suicide rate was 18.9 deaths per 100,000 Ohio Medicaid enrollees. Most decedents (83%) made a general medical or mental health visit within one year of suicide, with 50% doing so within 30 days and 27% within one week before death. In the year before suicide, the median number of visits was 16, indicating a subgroup with intensive service utilization. Decedents whose visits were proximal to suicide (within 30 days) rather than distal (31-365 days) were more likely to have individual and co-occurring behavioral and general medical conditions and to be Medicaid eligible through disability. In the year before suicide, most visits (79%) were outpatient general medical visits. Also in the year before suicide, decedents with serious psychiatric disorders were more likely than those without such disorders to make only mental health visits, and those with chronic general medical conditions were more likely than those without such conditions to make only general medical visits. Medicaid enrollment designates a "virtual boundary" around a subpopulation of health care consumers relevant to national suicide prevention efforts. Findings highlight the potential of using Medicaid data to identify individuals at risk of suicide for screening, prevention, and intervention.

Effect of Teledermatology on Access to Dermatology Care Among Medicaid Enrollees.

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Uscher-Pines, Lori; Malsberger, Rosalie; Burgette, Lane; Mulcahy, Andrew; Mehrotra, Ateev

2016-08-01

Access to specialists such as dermatologists is often limited for Medicaid enrollees. Teledermatology has been promoted as a potential solution; however, its effect on access to care at the population level has rarely been assessed. To evaluate the effect of teledermatology on the number of Medicaid enrollees who received dermatology care and to describe which patients were most likely to be referred to teledermatology. Claims data from a large California Medicaid managed care plan that began offering teledermatology as a covered service in April 2012 were analyzed. The plan enrolled 382 801 patients in California's Central Valley, including 108 480 newly enrolled patients who obtained coverage after the implementation of the Affordable Care Act. Rates of dermatology visits by patients affiliated with primary care practices that referred patients to teledermatology and those that did not were compared. Data were collected from April 1, 2012, through December 31, 2014, and assessed from March 1 to October 15, 2015. The percentage of patients with at least 1 visit to a dermatologist (including in-person and teledermatology visits) and total visits with dermatologists (including in-person and teledermatology visits) per 1000 patients. Of the 382 801 patients enrolled for at least 1 day from 2012 to 2014, 8614 (2.2%) had 1 or more visits with a dermatologist. Of all patients who visited a dermatologist, 48.5% received care via teledermatology. Among the patients newly enrolled in Medicaid, 75.7% (1474 of 1947) of those who visited a dermatologist received care via teledermatology. Primary care practices that engaged in teledermatology had a 63.8% increase in the fraction of patients visiting a dermatologist (vs 20.5% in other practices; P dermatology, teledermatology served more patients younger vs older than 17 years (2600 of 4427 [58.7%] vs 1404 of 4187 [33.5%]), male patients (1849 of 4427 [41.8%] vs 1526 of 4187 [36.4%]), nonwhite patients (2779 of 4188

The patient perspective: utilizing focus groups to inform care coordination for high-risk medicaid populations.

Science.gov (United States)

Sheff, Alex; Park, Elyse R; Neagle, Mary; Oreskovic, Nicolas M

2017-07-25

Care coordination programs for high-risk, high-cost patients are a critical component of population health management. These programs aim to improve outcomes and reduce costs and have proliferated over the last decade. Some programs, originally designed for Medicare patients, are now transitioning to also serve Medicaid populations. However, there are still gaps in the understanding of what barriers to care Medicaid patients experience, and what supports will be most effective for providing them care coordination. We conducted two focus groups (n = 13) and thematic analyses to assess the outcomes drivers and programmatic preferences of Medicaid patients enrolled in a high-risk care coordination program at a major academic medical center in Boston, MA. Two focus groups identified areas where care coordination efforts were having a positive impact, as well as areas of unmet needs among the Medicaid population. Six themes emerged from the focus groups that clustered in three groupings: In the first group (1) enrollment in an existing medical care coordination programs, and (2) provider communication largely presented as positive accounts of assistance, and good relationships with providers, though participants also pointed to areas where these efforts fell short. In the second group (3) trauma histories, (4) mental health challenges, and (5) executive function difficulties all presented challenges faced by high-risk Medicaid patients that would likely require redress through additional programmatic supports. Finally, in the third group, (6) peer-to-peer support tendencies among patients suggested an untapped resource for care coordination programs. Programs aimed at high-risk Medicaid patients will want to consider programmatic adjustments to attend to patient needs in five areas: (1) provider connection/care coordination, (2) trauma, (3) mental health, (4) executive function/paperwork and coaching support, and (5) peer-to-peer support.

Changes in Payer Mix and Physician Reimbursement After the Affordable Care Act and Medicaid Expansion

Directory of Open Access Journals (Sweden)

Christine D. Jones MD, MS

2015-08-01

Full Text Available Although uncompensated care for hospital-based care has fallen dramatically since the implementation of the Affordable Care Act and Medicaid expansion, the changes in hospital physician reimbursement are not known. We evaluated if payer mix and physician reimbursement by encounter changed between 2013 and 2014 in an academic hospitalist practice in a Medicaid expansion state. This was a retrospective cohort study of all general medicine inpatient admissions to an academic hospitalist group in 2013 and 2014. The proportion of encounters by payer and reimbursement/inpatient encounter were compared in 2013 versus 2014. A sensitivity analysis determined the relative contribution of different factors to the change in reimbursement/encounter. Among 37 540 and 40 397 general medicine inpatient encounters in 2013 and 2014, respectively, Medicaid encounters increased (17.3% to 30.0%, P < .001, uninsured encounters decreased (18.4% to 6.3%, P < 0.001, and private payer encounters also decreased (14.1% to 13.3%, P = .001. The median reimbursement/encounter increased 4.2% from $79.98/encounter in 2013 to $83.36/encounter in 2014 (P < .001. In a sensitivity analysis, changes in length of stay, proportions in encounter type by payer, payer mix, and reimbursement for encounter type by payer accounted for −0.7%, 0.8%, 2.0%, and 2.3% of the reimbursement change, respectively. From 2013 to 2014, Medicaid encounters increased, and uninsured and private payer encounters decreased within our hospitalist practice. Reimbursement/encounter also increased, much of which could be attributed to a change in payer mix. Further analyses of physician reimbursement in Medicaid expansion and non-expansion states would further delineate reimbursement changes that are directly attributable to Medicaid expansion.

Ramón y Cajal erroneously identified as Camillo Golgi on a souvenir postage stamp.

Science.gov (United States)

Triarhou, Lazaros C; del Cerro, Manuel

2012-01-01

Focusing on a philatelic oddity that erringly identifies a picture of Santiago Ramón y Cajal as that of Camillo Golgi, this brief article examines official and unofficial stamp issues honoring the two great neuroanatomists, one from Spain and the other from Italy, who were early Nobel Prize winners in Physiology or Medicine.

Medicare and Medicaid fraud and abuse regulations.

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Liang, F Z; Black, B L

1991-11-01

Specific business arrangements that are protected under legislation and regulations governing parties doing business with Medicare or Medicaid are discussed. Regulations implementing the Medicare and Medicaid Patient Protection Act of 1987 specify practices and activities that are not subject to criminal penalties under the antikickback provisions of the Social Security Act or to exclusion from Medicare or state health-care programs. As of July 29, 1991, all organized health-care settings that receive payments from either Medicare or state health-care programs must comply with these regulations. The final rule sets forth "safe harbors"--exceptions to prohibitions against (1) kickbacks, bribes, rebates, and other illegal activities involving remunerations for patient referrals and (2) inducements to purchase or lease goods paid for by Medicare or state health-care programs. The safe harbors comprise 11 broad categories--investment interests, space rental, equipment rental, personal services and management contracts, purchase of a medical practice, referral services, warranties, discounts, employees, group purchasing organizations, and waiver of deductibles and coinsurance. Implications for pharmacy are discussed. These regulations will affect the purchase of pharmaceuticals by institutional pharmacies. Each institution should review its current practices to determine whether they are within the safe harbors.

Defect detection and classification of galvanized stamping parts based on fully convolution neural network

Science.gov (United States)

Xiao, Zhitao; Leng, Yanyi; Geng, Lei; Xi, Jiangtao

2018-04-01

In this paper, a new convolution neural network method is proposed for the inspection and classification of galvanized stamping parts. Firstly, all workpieces are divided into normal and defective by image processing, and then the defective workpieces extracted from the region of interest (ROI) area are input to the trained fully convolutional networks (FCN). The network utilizes an end-to-end and pixel-to-pixel training convolution network that is currently the most advanced technology in semantic segmentation, predicts result of each pixel. Secondly, we mark the different pixel values of the workpiece, defect and background for the training image, and use the pixel value and the number of pixels to realize the recognition of the defects of the output picture. Finally, the defect area's threshold depended on the needs of the project is set to achieve the specific classification of the workpiece. The experiment results show that the proposed method can successfully achieve defect detection and classification of galvanized stamping parts under ordinary camera and illumination conditions, and its accuracy can reach 99.6%. Moreover, it overcomes the problem of complex image preprocessing and difficult feature extraction and performs better adaptability.

Can medicaid reimbursement help give female condoms a second chance in the United States?

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Witte, Susan S; Stefano, Kyle; Hawkins, Courtney

2010-10-01

The female condom is the only other barrier contraception method besides the male condom, and it is the only "woman-initiated" device for prevention of sexually transmitted infections. Although studies demonstrate high acceptability and effectiveness for this device, overall use in the United States remains low. The female condom has been available through Medicaid in many states since 1994. We provide the first published summary of data on Medicaid reimbursement for the female condom. Our findings demonstrate low rates of claims for female condoms but high rates of reimbursement. In light of the 2009 approval of a new, cheaper female condom and the recent passage of comprehensive health care reform, we call for research examining how health care providers can best promote consumer use of Medicaid reimbursement to obtain this important infection-prevention device.

Impact of Medicaid Managed Care on Illinois's Acute Health Services Expenditures for Adults with Intellectual and Developmental Disabilities

Science.gov (United States)

Yamaki, Kiyoshi; Wing, Coady; Mitchell, Dale; Owen, Randall; Heller, Tamar

2018-01-01

States have increasingly transitioned Medicaid enrollees with disabilities from fee-for-service (FFS) to Medicaid Managed Care (MMC), intending to reduce state Medicaid spending and to provide better access to health services. Yet, previous studies on the impact of MMC are limited and findings are inconsistent. We analyzed the impact of MMC on…

77 FR 31499 - Medicaid and Children's Health Insurance Programs; Disallowance of Claims for FFP and Technical...

Science.gov (United States)

2012-05-29

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 430, 433, 447, and 457 [CMS-2292-F] RIN 0938-AQ32 Medicaid and Children's Health Insurance Programs... Children's Health Insurance Program (CHIP) disallowance process to allow States the option to retain...

Fabrication of a silicon oxide stamp by edge lithography reinforced with silicon nitride for nanoimprint lithography

NARCIS (Netherlands)

Zhao, Yiping; Berenschot, Johan W.; de Boer, M.; de Boer, Meint J.; Jansen, Henricus V.; Tas, Niels Roelof; Huskens, Jurriaan; Elwenspoek, Michael Curt

2008-01-01

The fabrication of a stamp reinforced with silicon nitride is presented for its use in nanoimprint lithography. The fabrication process is based on edge lithography using conventional optical lithography and wet anisotropic etching of 110 silicon wafers. SiO2 nano-ridges of 20 nm in width were

Large Disparities in Receipt of Glaucoma Care between Enrollees in Medicaid and Those with Commercial Health Insurance.

Science.gov (United States)

Elam, Angela R; Andrews, Chris; Musch, David C; Lee, Paul P; Stein, Joshua D

2017-10-01

To determine whether the type of health insurance a patient possesses and a patient's race/ethnicity affect receipt of common tests to monitor open-angle glaucoma (OAG). Retrospective longitudinal cohort study. A total of 21 766 persons aged ≥40 years with newly diagnosed OAG between 2007 and 2011 enrolled in Medicaid or a large United States managed care network. We determined the proportion of patients with newly diagnosed OAG who underwent visual field (VF) testing, fundus photography (FP), other ocular imaging (OOI), or none of these tests within the first 15 months after initial OAG diagnosis. Multivariable logistic regression was used to assess the extent by which health insurance type and race/ethnicity affected the odds of undergoing glaucoma testing. Odds ratios (OR) of undergoing VF testing, FP, OOI, or none of these tests in the 15 months after initial OAG diagnosis with 95% confidence intervals (CI). A total of 18 372 persons with commercial health insurance and 3394 Medicaid recipients met the study inclusion criteria. The proportions of persons with commercial health insurance with newly diagnosed OAG who underwent VF, FP, and OOI were 63%, 22%, and 54%, respectively, whereas the proportions were 35%, 19%, and 30%, respectively, for Medicaid recipients. Compared with those with commercial health insurance, Medicaid recipients were 234% more likely to not receive any glaucoma testing in the 15 months after initial diagnosis (OR = 3.34; 95% CI, 3.07-3.63). After adjustment for confounders, whites with OAG enrolled in Medicaid had 198% higher odds of receiving no glaucoma testing compared with whites possessing commercial health insurance (OR = 2.98; 95% CI, 2.66-3.33). Blacks with Medicaid insurance demonstrated 291% higher odds (OR = 3.91; 95% CI, 3.40-4.49) of not receiving any glaucoma testing compared with blacks with commercial health insurance. Irrespective of race/ethnicity, Medicaid recipients with OAG are receiving substantially less

Medicaid managed care for mental health services: the survival of safety net institutions in rural settings.

Science.gov (United States)

Willging, Cathleen E; Waitzkin, Howard; Nicdao, Ethel

2008-09-01

Few accounts document the rural context of mental health safety net institutions (SNIs), especially as they respond to changing public policies. Embedded in wider processes of welfare state restructuring, privatization has transformed state Medicaid systems nationwide. We carried out an ethnographic study in two rural, culturally distinct regions of New Mexico to assess the effects of Medicaid managed care (MMC) and the implications for future reform. After 160 interviews and participant observation at SNIs, we analyzed data through iterative coding procedures. SNIs responded to MMC by nonparticipation, partnering, downsizing, and tapping into alternative funding sources. Numerous barriers impaired access under MMC: service fragmentation, transportation, lack of cultural and linguistic competency, Medicaid enrollment, stigma, and immigration status. By privatizing Medicaid and contracting with for-profit managed care organizations, the state placed additional responsibilities on "disciplined" providers and clients. Managed care models might compromise the rural mental health safety net unless the serious gaps and limitations are addressed in existing services and funding.

Medicaid Expansion And Grant Funding Increases Helped Improve Community Health Center Capacity.

Science.gov (United States)

Han, Xinxin; Luo, Qian; Ku, Leighton

2017-01-01