Read each discussion and make one reply to each discussion. These replies do not need to be formal – but professional in nature. Include citations and references. 2 references for each reply. Ask 1 questions at the end of each reply. Each reply needs to be 137 Words
Discussion 1
The complexity of policymaking is widely apparent as one studies the various theories, models, and frameworks that surround this topic. One of the more widely accepted policymaking models involves the following 3 phases: formulation, implementation, and modification (Meacham, 2021). This discussion post, however, will focus on the third and final phase: modification. In the modification phase, it is often necessary to revise or modify a law. As time presses on, sometimes areas of improvement or necessity may come to light that require policy modification (Meacham, 2021). For this discussion, as I placed myself within the scenario of working for President Biden to evaluate a current health policy through the lens of the modification phase, I immediately chose the “No Surprises Act.” This is a policy that only recently (as in several weeks ago) came to my attention. In fact, I am currently part of a team that is writing a new financial policy and procedure regarding the way our clinic front desk staff educate our patients on this act.
The “No Surprises Act” went into effect on January 1st, 2022, and it covers, but is not limited to, the following:
In many circumstances, the policy prohibits “balance billing” which is defined as the difference between the amount that the provider charges and the amount that the patient’s insurance will pay plus the patient’s amount for cost-sharing (“The No Surprises,” n.d.).
Prohibits most emergency services that may be provided out-of-network and/or without prior authorization (“No Surprises,” 2022).
Prohibits out-of-network copays for nearly all emergency and some non-emergency services (“No Surprises,” 2022).
For those patients that are uninsured, the policy requires the providers create a “good faith estimate” prior to the patient receiving care (“No Surprises,” 2022).
Bans the use of balance billing for “air ambulance services” (“The No Surprises,” n.d.).
Bans balancing billing on services provided by air ambulances (“The No Surprises,” n.d.).
Not only am I currently learning more about this law at work, but I also had a personal experience that allowed me to relate to the benefits of this law. In 2019, I was on vacation in California when I became very ill and was rushed by ambulance (ground ambulance) to the nearest emergency room. I wound up being admitted to the hospital for two days and after I was discharged and had been at home for about thirty days, I got one of the biggest shocks of my life when I received a bill for around $26,000.00. Not only had I visited an out-of-network hospital, I had also arrived via ground ambulance which was an added expense. I was astounded and incredibly stressed out with the potential of having to pay this bill. I had insurance through my employer at the time but because the hospital was out of network, I was stuck at an impasse for a long while. For the sake of brevity, I was finally relieved of having to pay that bill after two years of back-and-forth arbitration. It was an absolute nightmare and an experience that I never wish to repeat. Had the “No Surprises Act” been implemented in 2019, I would have certainly had a greater peace of mind!
Regarding the “No Surprises Act,” I believe it is a very thorough policy and I am mostly satisfied with everything it covers. I would, however, modify the policy to include ground ambulance services. From my personal experience, the cost of the ambulance was small compared to the hospital stay, but still expensive (in my opinion)! To this day, I would refuse a ground ambulance if I became ill or injured and one came to me for transport. I simply do not have that kind of money to pay for emergency services. I did learn that ground ambulance protection is now provided by the following 10 states, which is a start, I suppose. The states are as follows: Colorado, Delaware, Florida, Illinois, Maine, Maryland, New York, Ohio, Vermont, and West Virgina (“No Surprises Act Considerations,” 2022). In addition to my thoughts on this matter, I have seen and heard of a number of other people who would also refuse an ambulance ride, which, for some people could mean the difference between life and death. It is certainly not the healthiest line of thinking! References
Centers for Medicare & Medicaid Services. (n.d.). The no surprises act’s prohibitions on balancing billing. Center for Consumer Information & Insurance Oversight. https://www.cms.gov/files/document/a274577-1a-training-1-balancing-billingfinal508.pdfLinks to an external site.
CMS.gov (2022, January 3). No surprises: understand your rights against surprise medical bills. https://www.cms.gov/newsroom/fact-sheets/no-surprises-understand-your-rights-against-surprise-medical-billsLinks to an external site.
Meacham, M. R. (2021). Longest’s health policymaking in the United States (7th ed.). Health Administration Press.
Mori, M. (2022, August 24). No surprises act considerations for ground ambulance billing. MossAdams. https://www.mossadams.com/articles/2022/08/no-surprises-act-for-ground-ambulance-billingLinks to an external site.
Discussion 2 An out-of-control virus was about to take over the world and changed countless lives forever. It’s called Coronavirus 2019 (Covid-19) which is a disease that resulted from a virus named SARS-CoV-2. COVID-19 was first identified in China in 2019. By 2020 there was an outbreak of the disease, and the World Health Organization (WHO) declared a pandemic (Mayo Foundation for Medical Education and Research). The first Covid-19 case was published in the United States in January 31,2020. By mid-year 2021, there were 34.4 million diagnosed cases and more than 608,000 people lost their lives in the United States and more than 4.1 million deaths worldwide (Bok, Sitar, et al., 2021).
In response to the outbreak both the private and public sectors worked to develop ways to treat and prevent the virus. Prior to the pandemic, researchers were already actively studying ways to protect against the coronaviruses. This made it much easier and quicker for researchers to develop a vaccine to fight against the virus (ASPA, 2023). The Food and Drug Administration (FDA) is responsible for reviewing and evaluating the Covid-19 vaccine to ensure safety, quality, and effectiveness, and an analysis is done to ensure that it meets the benefits and risks according to the FDA approval standards. The FDA is also responsible for issuing Emergency Use Authorizations (EUA). The Advisory Committee on Immunization Practices (ACIP) also referred to as independent health and medical experts got together and provided the Director of the Centers for Disease Control and Prevention (CDC) with recommendations and guidance related to the vaccine (ASPA, 2023).
The first EUA was issued on December 11, 2020, for use of the Pfizer-BioNTech COVID-19 vaccine for individuals aged 16 years and older and on December 14, 2020, the first set of vaccines were administered. Following was the Moderna COVID-19 vaccine, which was issued by the FDA on December 18, 2020, for individuals 18 years and older. On February 27, 2021, the FDA issued another EUA for the Janssen COVID-19 vaccine for individuals 18 years and older (ASPA, 2023). After the implementation of policies, there is still the need to go through an evaluation process to ensure they continue to meet the intended objectives. This is where the modification phase comes in because policies may need to be modified to increase its overall benefits (Meacham,2021, pp.220-221). These statements are in line with the number of additional modifications to the vaccine policies that followed which included expanding the age requirements for those who are eligible for the vaccines. The final modification for the age requirement was announced on December 9, 2022, in which children as young as 6 months of age were eligible to receive the Moderna and Pfizer-BioNTech vaccines. The FDA also amended the EUA for eligible individuals to receive a single booster vaccine (ASPA, 2023).
There were several mandates and exemptions that were issued as a result of Covid-19 such as for noncitizen air travelers, military personnel, federal government employees, private sector employees, health care workers, and federal contractors (Wikimedia Foundation, 2023). As of May 11, 2023, these mandates have been withdrawn by the administration and therefore no longer apply. Today, more people have been vaccinated against the vaccine. The number of individuals contracting the disease has decreased significantly although the virus is still active. Some individuals still wear masks voluntarily to protect themselves. I believe people are more cognizant about their health and have a better understanding of how to protect themselves. Therefore, with the mandates lifted, I don’t think there are any modifications needed at this time.
References
Assistant Secretary for Public Affairs (ASPA). (2023, September 13). COVID-19 Vaccines. HHS.gov. https://www.hhs.gov/coronavirus/covid-19-vaccines/index.html
Bok, K., Sitar, S., Graham, B. S., & Mascola, J. R. (2021, August 10). Accelerated COVID-19 vaccine development: milestones, lessons, and prospects. Immunity. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8328682/
Mayo Foundation for Medical Education and Research. (n.d.). History of COVID-19: Outbreaks and Vaccine Timeline. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/history-disease-outbreaks-vaccine-timeline/covid-19Links to an external site.
Meacham, M. R. (2021). Longest’s Health Policymaking in the United States (7th ed.). Health Administration Press.
Wikimedia Foundation. (2023, September 2). COVID-19 vaccination mandates in the United States. Wikipedia. https://en.wikipedia.org/wiki/COVID-19_vaccination_mandates_in_the_United_States#cite_note-52