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 Collection: Congressional Research Service Reports
Centers for Medicare & Medicaid Services (CMS) Proposed Rule on Medicaid Managed Care: Frequently Asked Questions

Centers for Medicare & Medicaid Services (CMS) Proposed Rule on Medicaid Managed Care: Frequently Asked Questions

Date: July 15, 2015
Creator: Blom, Kirstin B.
Description: This report responds to a series of frequently asked questions (FAQs) identified to address some of the major updates included in the proposed rule. The FAQs summarize provisions such as the introduction of a minimum medical loss ratio (MLR), guidance on enrolling the long-term services and supports (LTSS) population in managed care, and network adequacy.
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Health Savings Accounts: Overview of Rules for 2012

Health Savings Accounts: Overview of Rules for 2012

Date: December 20, 2011
Creator: Mulvey, Janemarie
Description: This report provides a summary of the principal rules governing Health Savings Accounts (HSAs), covering such matters as eligibility, qualifying health insurance, contributions, and withdrawals.
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Mental Health Parity and the Patient Protection and Affordable Care Act of 2010

Mental Health Parity and the Patient Protection and Affordable Care Act of 2010

Date: December 28, 2011
Creator: Sarata, Amanda K.
Description: This report provides a brief background on mental health parity and the policy discussion around parity in health insurance coverage; an overview of federal mental health parity law prior to the enactment of the ACA; and an analysis of the impact of the ACA.
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Mental Health Parity and the Patient Protection and Affordable Care Act of 2010

Mental Health Parity and the Patient Protection and Affordable Care Act of 2010

Date: January 7, 2011
Creator: Sarata, Amanda K.
Description: This report provides a brief background on mental health parity and the policy discussion around parity in health insurance coverage; an overview of federal mental health parity law prior to the enactment of the ACA; and an analysis of the impact of the ACA.
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Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis

Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis

Date: February 1, 2011
Creator: Staman, Jennifer; Brougher, Cynthia; Liu, Edward C.; Lunder, Erika K. & Thomas, Kenneth R.
Description: This report first analyzes the authority of Congress to enact the minimum essential coverage requirement contained in Patient Protection and Affordable Care Act (PPACA), as well as how a court might analyze this provision if challenged based on various provisions of the Fifth and Tenth Amendments. This report discusses whether there must be exceptions to a requirement to purchase health insurance based on First Amendment freedom of religion, and finally, discusses some of the legal challenges to this federal requirement.
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Community Living Assistance Services and Supports (CLASS) Provisions in the Patient Protection and Affordable Care Act (PPACA)

Community Living Assistance Services and Supports (CLASS) Provisions in the Patient Protection and Affordable Care Act (PPACA)

Date: January 5, 2011
Creator: Mulvey, Janemarie & Colello, Kirsten J.
Description: This report first discusses the cost and financing for long-term care (LTC) services as well as the current market for private LTC insurance. It then details those CLASS program requirements for enrollment, premiums, eligibility, benefits, administration, and oversight. The report also discusses federal budget implications, as estimated by the Congressional Budget Office (CBO) and the Centers for Medicare and Medicaid Services (CMS). Finally, the report provides a timeline of the CLASS program provisions enacted under PPACA.
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Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis

Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis

Date: December 16, 2010
Creator: Staman, Jennifer; Brougher, Cynthia; Liu, Edward C.; Lunder, Erika K. & Thomas, Kenneth R.
Description: This report first analyzes the authority of Congress to enact the minimum essential coverage requirement contained in the Patient Protection and Affordable Care Act (PPACA), as well as how a court might analyze this provision if challenged based on various provisions of the Fifth and Tenth Amendments. This report discusses whether there must be exceptions to a requirement to purchase health insurance based on First Amendment freedom of religion, and finally, discusses some of the legal challenges to this federal requirement.
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Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis

Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis

Date: May 7, 2010
Creator: Staman, Jennifer; Brougher, Cynthia; Liu, Edward C.; Lunder, Erika K. & Thomas, Kenneth R.
Description: This report first analyzes the authority of Congress to pass a law of this nature, as well as how a court could analyze this provision in light of a constitutional challenge based on various provisions of the Fifth and Tenth Amendments. Finally, this report discusses whether the exceptions to the individual responsibility requirement to purchase health insurance satisfy First Amendment freedom of religion protections.
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Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis

Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis

Date: July 24, 2009
Creator: Staman, Jennifer & Brougher, Cynthia
Description: This report first analyzes the authority of Congress to pass a proposal of this nature, as well as how a court could analyze this type of proposal if there were to be a constitutional challenge based on various provisions of the Fifth Amendment. Finally, this report discusses whether there must be exceptions to a requirement to purchase health insurance based on First Amendment freedom of religion.
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Medicaid Expenditures, FY2003 and FY2004

Medicaid Expenditures, FY2003 and FY2004

Date: January 17, 2006
Creator: Tritz, Karen
Description: This report discusses the federal medical assistance percentage (FMAP), which is the percentage of Medicaid benefit costs paid for by the federal government.
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Environmental Exposure to Endocrine Disruptors: What Are the Human Health Risks?

Environmental Exposure to Endocrine Disruptors: What Are the Human Health Risks?

Date: February 4, 2002
Creator: Schierow, Linda-Jo & Buck, Eugene H.
Description: This report discusses the human health risks, specifically from endocrine disruptors that are chemical compounds in drugs, food, consumer products, or the ambient environment that can interfere with internal biological processes of animals that normally are regulated by their hormones.
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Public Health, Workforce, Quality, and Related Provisions in H.R. 3962

Public Health, Workforce, Quality, and Related Provisions in H.R. 3962

Date: November 5, 2009
Creator: Redhead, C. Stephen
Description: This report discusses health care reform, which was at the top of the domestic policy agenda for the 111th Congress, driven by concerns about the growing ranks of the uninsured and the unsustainable growth in spending on health care and health insurance.
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Medicare Primer

Medicare Primer

Date: September 10, 2014
Creator: Davis, Patricia A.; Talaga, Scott R.; Binder, Cliff; Hahn, Jim; Morgan, Paulette C.; Mulvey, Janemarie et al.
Description: This report provides an overview of Medicare, the nation's federal insurance program, which pays for covered health care services of qualified beneficiaries.
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Medicaid Reimbursement Policy

Medicaid Reimbursement Policy

Date: November 2, 2004
Creator: Merlis, Mark
Description: This report begins with a summary of basic federal requirements applicable to payments for all services and an overview of major developments in federal Medicaid reimbursement policy over the last 20 years. This overview provides a historical context for current policies and highlights some issues that have been perennial concerns for federal and state policymakers. The next four sections of the report provide a detailed discussion of Medicaid reimbursement for four basic categories of services or providers.
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The Title X Family Planning Program

The Title X Family Planning Program

Date: March 22, 2005
Creator: Coleman, Sharon K.
Description: This report discusses Title X of the Public Health Service Act. The program, enacted in 1970, is the only federal program devoted solely to family planning and related preventive health services. Although the authorization for Title X ended with FY1985, funding for the program has been provided through bills that provide appropriations for the Departments of Labor, Health and Human Services, and Education, and Related Agencies.
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Medicaid and SCHIP: The President’s FY2006 Budget Proposals

Medicaid and SCHIP: The President’s FY2006 Budget Proposals

Date: February 15, 2005
Creator: Grady, April; Hearne, Jean P; Herz, Elicia J; Scott, Christine; Stone-Axelrad, Julie & Tritz, Karen
Description: This report describes the proposal and provides an estimate of the cost or savings based on publicly available information. The report provides a brief background for the proposal and provides a listing of current Congressional Research Service (CRS) reports related to the proposal.
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Tax Benefits for Health Insurance and Expenses: Overview of Current Law and Legislation

Tax Benefits for Health Insurance and Expenses: Overview of Current Law and Legislation

Date: April 28, 2008
Creator: Lyke, Bob & Whittaker, Julie M.
Description: This report discusses how tax policy affects health insurance and health care spending.
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Prescription Drug Coverage Under Medicaid

Prescription Drug Coverage Under Medicaid

Date: February 6, 2008
Creator: Hearne, Jean
Description: Medicaid is a joint federal-state entitlement program that pays for medical services on behalf of certain groups of low-income persons. It is the third largest social program in the federal budget, exceeded only by Social Security and Medicare and is typically the second largest spending item for states. This report discusses prescription drug policies under the program.
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Prescription Drug Coverage Under Medicaid

Prescription Drug Coverage Under Medicaid

Date: February 21, 2006
Creator: Hearne, Jean
Description: Medicaid is a joint federal-state entitlement program that pays for medical services on behalf of certain groups of low-income persons. It is the third largest social program in the federal budget, exceeded only by Social Security and Medicare and is typically the second largest spending item for states. This report discusses prescription drug policies under the program.
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The ACA Medicaid Expansion

The ACA Medicaid Expansion

Date: December 30, 2014
Creator: Mitchell, Alison
Description: This report provides an overview of the ACA Medicaid expansion, and the impact of the Supreme Court decision on the ACA Medicaid expansion. Then, the report describes who is covered under the expansion, the expansion rules, and how the expansion is financed. In addition, enrollment and expenditure estimates for the ACA Medicaid expansion are provided. Finally, the report reviews state decisions whether or not to implement the ACA Medicaid expansion, and the implications of those decisions on certain individuals, employers, and hospitals.
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Health Insurance Coverage for Retirees

Health Insurance Coverage for Retirees

Date: March 28, 2006
Creator: Chaikind, Hinda
Description: With the retirement of the baby boom generation looming ahead, employers offering coverage to their retired workers will face a huge future financial commitment. Some employers have already reduced or eliminated their commitment to insure their retirees. Recent trends indicate that retiree health benefits are increasingly subject to higher beneficiary cost-sharing. Further, among employers who provide health insurance for current retirees, their current workers are less likely to be guaranteed these benefits upon retirement. This report discusses issues regarding health insurance coverage for retirees.
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Health Insurance Coverage for Retirees

Health Insurance Coverage for Retirees

Date: January 22, 2007
Creator: Chaikind, Hinda
Description: With the retirement of the baby boom generation looming ahead, employers offering coverage to their retired workers will face a huge future financial commitment. Some employers have already reduced or eliminated their commitment to insure their retirees. Recent trends indicate that retiree health benefits are increasingly subject to higher beneficiary cost-sharing. Further, among employers who provide health insurance for current retirees, their current workers are less likely to be guaranteed these benefits upon retirement. This report discusses issues regarding health insurance coverage for retirees.
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Medicare Home Health Benefit Primer: Benefit Basics and Issues

Medicare Home Health Benefit Primer: Benefit Basics and Issues

Date: February 6, 2014
Creator: Talaga, Scott R.
Description: This report describes home health eligibility criteria, home health services, characteristics of Medicare beneficiaries who use home health services, and home health providers. Further, this report describes in detail the Medicare home health prospective payment system (HH PPS), provides an overview of Medicare home health payments, and discusses issues for Congress related to the Medicare home health benefit.
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Medicare: FY2008 Budget Issues

Medicare: FY2008 Budget Issues

Date: February 6, 2007
Creator: Chaikind, Hinda; Jacobson, Gretchen A.; Hahn, Jim; Morgan, Paulette C.; O’Sullivan, Jennifer & Stockdale, Holly Sue
Description: This report discusses President's budget request to Congress for Medicare, for the following federal fiscal year, along with projections for the five-year budget window. The President’s 2008 budget includes Medicare legislative proposals with estimated savings of $4.3 billion in 2008 and $65.6 billion over the five-year budget window.
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