Federal Mandates Research Articles

A Mixed-Methods Analysis of State-Level Population Data for Students With Visual Impairment and Blindness

The prevalence of students with visual impairments varies across the United States, yet limited analysis exists on how many students receive special education services. The following study collected population data on students with visual impairments for the 2017–2018 school year and ran focus groups with state-level administrators to understand current and future options to collect population data. Twenty-three of 50 states responding to the survey reported total population data. On average, states supported 3.6 times the number of students with visual impairments reported in their federal Child Count data reports. State administrators agreed a federal mandate requiring states to collect total population data on students with visual impairments is needed. The ramifications of preparing for and supporting an unknown population of students with disabilities was discussed. A federal mandate for total population data collection is unlikely in the near future. Therefore, practical implications, including key factors and logistics, that state administrators should consider are outlined.

The impact of public health messaging and personal experience on the acceptance of mask wearing during the COVID-19 pandemic

Face coverings have been shown to slow the spread of COVID-19, yet their use is not universal and remains controversial in the United States. Designing effective nudges for widespread adoption is important when federal mandates are politically or legally infeasible. We report the results from a survey experiment in which subjects were exposed to one of three video messages from President Trump, and then indicated their preference for wearing a mask. In the first video, the President simply recited the Centers for Disease Control and Prevention (CDC) guidelines. In the second, the President additionally emphasized that wearing a mask is optional. In the third video, the President added that he will not personally wear a mask. We find that exposure to presidential messages can increase the stated likelihood of wearing a mask—particularly among the President’s supporters. We also explore experiential effects of COVID-19, and find that people (especially supporters of the President) are more likely to support wearing a mask if they know someone who has tested positive for COVID-19. These results offer guidance to policy makers and practitioners interested in understanding the factors that influence viral risk mitigation strategies.

Regulations and Standards Aware Framework for Recording of mHealth App Vulnerabilities

The authors describe a standards-based security framework for the purposes of recording security and privacy vulnerabilities discovered in mHealth apps. The proposed framework is compliant with the international standard for software architecture descriptions, ISO/IEC/IEEE 42010, relevant state-agency regulations, and US federal healthcare mandates, as well as computing standards for data interchange formats. Future real-life implementations are envisioned to consists of three key components: (1) design and implementation of a repository that links vulnerabilities to concepts from the taxonomy used by legislative and standardization bodies; (2) population of the repository with security vulnerability descriptions that follow a standard format, such as JavaScript Object Notation (JSON); and (3) implementation of a searchable user interface (e.g., Google's Firebase UI), which allows for aggregation statistics, data analytics, as well as public access to the repository. The proposed framework design promotes timely updates of regulations, standardization drafts, and app development platforms.

Cardiopulmonary Exercise Testing in the Coronavirus Disease - 2019 Era: Safety and Protocol Considerations.

Cardiopulmonary exercise testing (CPX) is a valuable tool in both clinical practice and research settings. Therefore, it is advantageous for human performance laboratories to continue operating during the coronavirus disease 2019 (COVID-19) pandemic. All institutions should adhere to general COVID-19 guidelines provided by the Centers for Disease Control. Because of the testing environment, CPX laboratories must consider additional precautionary safety measures. This article provides recommendations for modifying the CPX protocol to ensure safety for all stakeholders during the pandemic. These modifications are universal across all populations, types of institutions and testing modalities. Preliminary measures include careful review of federal, local, and institutional mandates. The description outlines how to evaluate a testing environment and alter workflow. Guidelines are provided on what specific personal protective equipment should be acquired; as well as necessary actions before, during, and after the CPX test. These precautions will limit the possibility of both clients and staff from contracting or spreading the disease while maintaining testing volume in the laboratory.

Balancing the need for seed against invasive species risks in prairie habitat restorations.

Adequate diversity and abundance of native seed for large-scale grassland restorations often require commercially produced seed from distant sources. However, as sourcing distance increases, the likelihood of inadvertent introduction of multiple novel, non-native weed species as seed contaminants also increases. We created a model to determine an “optimal maximum distance” that would maximize availability of native prairie seed from commercial sources while minimizing the risk of novel invasive weeds via contamination. The model focused on the central portion of the Level II temperate prairie ecoregion in the Midwest US. The median optimal maximum distance from which to source seed was 272 km (169 miles). In addition, we weighted the model to address potential concerns from restoration practitioners: 1. sourcing seed via a facilitated migration strategy (i.e., direct movement of species from areas south of a given restoration site to assist species’ range expansion) to account for warming due to climate change; and 2. emphasizing non-native, exotic species with a federal mandate to control. Weighting the model for climate change increased the median optimal maximum distance to 398 km (247 miles), but this was not statistically different from the distance calculated without taking sourcing for climate adaptation into account. Weighting the model for federally mandated exotic species increased the median optimal maximum distance only slightly to 293 km (182 miles), so practitioners may not need to adjust their sourcing strategy, compared to the original model. This decision framework highlights some potential inadvertent consequences from species translocations and provides insight on how to balance needs for prairie seed against those risks.

Private coverage mandates, business cycles, and provider treatment intensity.

The Affordable Care Act (ACA) is the source of multiple large-scale health insurance expansions affecting various segments of the US population. Although much has been done to quantify the first-order effects of these policies, less empirical investigation has been devoted to the effects on the supply-side of health care. We focus on a well-known ACA initiative (the young adult dependent coverage mandate) to offer novel evidence on two fronts: the policy's heterogeneous effect across different labor markets and the potential for the policy-induced shift in payer mix to influence provider treatment decisions. First, we show that the federal mandate's direct effect on young adult private insurance take-up is strongly mitigated by the Great Recession. Second, we demonstrate that providers do not treat young adults more aggressively when more of them hold private coverage. Policymakers should keep these broader considerations and more diffuse risk protection implications in mind when contemplating changes to the law.

A Legal Paradigm for the Health Inequity Crisis

People of color and the poor die younger than the white and prosperous. And when they are alive, they are sicker. Health inequity is morally tragic. But it is also economically inefficient, raising the nation’s healthcare bill and lowering productivity. The COVID pandemic only, albeit dramatically, highlights these pre-existing inequities. COVID sufferers of color die at twice the rate of whites. The cause, in large part, is structural inequality and racism. Neither the popular nor the scholarly discussion of health care inequity, while robust, has translated into palpable and rapid progress. This Article describes why health inequity has so far proven intractable. In the healthcare system, no one actor has both adequate incentive and adequate wherewithal to create progress. The healthcare system cannot solve the problem alone. To jumpstart reform, the Article makes the case for a new regulatory approach, grounded in principles of democratic experimentalism, cooperative federalism, and adaptive management. It draws inspiration from the examples that the Health Insurance Portability and Accountability Act (HIPAA) and the Clean Air Act provide. A federal health equity mandate, with funding and penalties for state non-compliance, will spur collaboration between federal, state, local, public and private entities, and start the U.S. on the path to remediating health care’s inequities.

Rules of Medical Necessity

Health insurance contracts have long excluded coverage for care that is “experimental” or not “medically necessary.” Historically, insurance policies defined these key terms of coverage using broad standards. For example, “medically necessary” care might be defined as care that is “generally accepted in the medical community.” This contractual structure provided insurers with significant flexibility when making coverage determinations, even though denying coverage could pad their bottom line. For this reason, lawmakers developed various tools to prevent insurers from exploiting their discretion to determine when care was “medically necessary” or “experimental.” These safeguards allowed insureds to challenge coverage denials internally within the insurance company, externally to an independent medical expert, and before courts via a contract law or ERISA cause of action. Additionally, state and federal mandates required insurers to cover specific medically necessary treatments and services. This Article documents a dramatic shift in health insurers’ contracts and practices from a standard-based approach to determining the medical and scientific appropriateness of health care towards a rule-based approach for making these determinations. It shows how health insurers have increasingly made incredibly detailed and specific rules of medical necessity part of their formal contractual obligations to policyholders. The Article then argues that health insurers’ shift from standards to rules for defining medically and scientifically appropriate health care undermines the effectiveness of traditional legal tools designed to constrain the risk of health insurer over-reaching. The Article concludes by exploring reforms that might effectively address the increasing rulification of medical necessity.

Improving health equity: improving access to heart and brain medications for women

Access to medications remains an area of inequity and fragmentation with women disproportionately impacted. The development of a pharmacare program is now a federal government mandate commitment. This provides an opportunity to ensure all people have access to pharmacological treatments that prevent and treat cardio and cerebrovascular disease.

Rates of COVID-19 Among Residents and Staff Members in Nursing Homes - United States, May 25-November 22, 2020.

During the beginning of the coronavirus disease 2019 (COVID-19) pandemic, nursing homes were identified as congregate settings at high risk for outbreaks of COVID-19 (1,2). Their residents also are at higher risk than the general population for morbidity and mortality associated with infection with SARS-CoV-2, the virus that causes COVID-19, in light of the association of severe outcomes with older age and certain underlying medical conditions (1,3). CDC's National Healthcare Safety Network (NHSN) launched nationwide, facility-level COVID-19 nursing home surveillance on April 26, 2020. A federal mandate issued by the Centers for Medicare & Medicaid Services (CMS), required nursing homes to commence enrollment and routine reporting of COVID-19 cases among residents and staff members by May 25, 2020. This report uses the NHSN nursing home COVID-19 data reported during May 25-November 22, 2020, to describe COVID-19 rates among nursing home residents and staff members and compares these with rates in surrounding communities by corresponding U.S. Department of Health and Human Services (HHS) region.* COVID-19 cases among nursing home residents increased during June and July 2020, reaching 11.5 cases per 1,000 resident-weeks (calculated as the total number of occupied beds on the day that weekly data were reported) (week of July 26). By mid-September, rates had declined to 6.3 per 1,000 resident-weeks (week of September 13) before increasing again, reaching 23.2 cases per 1,000 resident-weeks by late November (week of November 22). COVID-19 cases among nursing home staff members also increased during June and July (week of July 26 = 10.9 cases per 1,000 resident-weeks) before declining during August-September (week of September 13 = 6.3 per 1,000 resident-weeks); rates increased by late November (week of November 22 = 21.3 cases per 1,000 resident-weeks). Rates of COVID-19 in the surrounding communities followed similar trends. Increases in community rates might be associated with increases in nursing home COVID-19 incidence, and nursing home mitigation strategies need to include a comprehensive plan to monitor local SARS-CoV-2 transmission and minimize high-risk exposures within facilities.

Vacci-Nation: A Look At Federal Authority to Mandate Vaccines

Vaccine mandates have historically been implemented and regulated by the states, not the federal government .Nevertheless, the federal government has “broad, flexible power” to prevent the spread of communicable disease among the states through Section 361 of the Public Health Service Act (Section 361). Although the federal government has never used Section 361 to mandate a vaccine to prevent the spread of disease and the authority to mandate a vaccine is not expressly provided in the statute, there is speculation that the federal government could use Section 361 to mandate a vaccine to prevent the spread of disease. However, there is no authoritative interpretation of the scope of the powers in Section 361, and the text remains ambiguous. This Comment sets aside the question of whether the federal government should mandate a vaccine and instead explores whether the federal government could mandate a vaccine through Section 361. Ultimately, this Comment concludes that Section 361 allows for a federal vaccine mandate and recommends a framework for determining when a federal vaccine mandate is a reasonable and necessary measure.

Antipsychotic treatment for youth in foster care: Perspectives on improving youths' experiences in providing informed consent.

The disproportionate prescribing of high-risk antipsychotic medication for youth in foster care is a significant social problem across the U.S. This qualitative study examined stakeholder perceptions of prescribing, being prescribed, or overseeing prescriptions for youth in foster care. Interviews and focus groups were conducted with clinicians, child welfare caseworkers, foster caregivers, and foster care alumni. The overall aim was to systematically explore their understanding of and experiences with the Informed Consent to treatment and shared decision-making processes related to prescribing and monitoring of antipsychotic medications for youth in foster care. Participants were recruited from around the country; data collection using structured interview or focus group guides occurred via telephone and web-based formats. This study is rooted in the lived experiences of stakeholders in addressing recent federal legislative mandates and guidelines for the oversight and co-ordination of mental health service delivery to youth in foster care. Numerous themes emerged that provide context in employing a team-based approach for youth engaged with multiple child-serving systems. Eight themes emerged that illustrate the necessary components of successfully implementing Informed Consent and shared decision-making as well as the barriers and concerns germane to this process. The findings address the nuanced complexity of and tensions with the trade-offs inherent in delivering mental health care to youth involved in foster care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Right Man for the Job: Manhood, Race, and Oklahoma Football in the Mid-1960s

In the fall of 1965 the football team at the University of Oklahoma experienced one of the worst seasons in its storied history. As the losses mounted, school officials found themselves embroiled in controversy and the recipients of an intense outpouring of communication from the team's legions of supporters. Advice, most of it unsolicited, flooded into the university from around the country, but especially from Oklahoma and Texas. Disappointed fans focused their frustrations on head coach Gomer Thomas Jones, and following his resignation at the end of the season, they offered their opinions regarding the type of man who could restore the Oklahoma football program to the position of national prominence it enjoyed just a few years earlier. Read today, these letters, memos, postcards, telegrams, and newspaper clippings provide a fascinating perspective on the prominent role a highly commercialized spectator sport played in the life of a major state university during the mid-1960s. They also move beyond sport to highlight basic cultural attitudes regarding manhood and race dominant in the Great Plains and in Middle America during this period. As they searched for a new coach, Oklahoma fans demonstrated a strong affinity for traditional constructions of masculine leadership and race relations. Confronting a period of rapid change, with federal mandates demanding a reconstruction of the racial order, they simultaneously grappled with updating those models to meet the new realities of life at the height of the Cold War.

Inventing in a Crisis: Lighting the United States after the 1973 Oil Embargo.

Political events can shape innovations. The 1973 oil embargo pushed the U.S. lighting industry to develop energy-saving lamps and designs. It led to federal mandates for lighting efficiency standards. This article examines changes in lighting system technology during the 1970s and 1980s in their historical context and describes their effect on subsequent public policy. At first, manufacturers introduced novel devices for diverse markets, depending on how much new research was required and whether they expected public demand for efficiency to be temporary or structural. The industry's design practices experienced a contentious cultural shift, in which energy efficiency became the dominant concern rather than a low priority. Post-embargo decisions by producers, conveyors, and consumers combined to shift path dependencies in lighting. They shaped subsequent market and regulatory actions that fed revolutionary changes in lighting in the 2010s.

Re-thinking patient stability for methadone in opioid treatment programs during a global pandemic: Provider perspectives

COVID-19 necessitated rapid changes in methadone take-home policies in opioid treatment programs (OTPs); these changes markedly contrast with existing, long-standing federal mandates on OTP rules about take-home methadone. OTP providers describe how these changes have affected clinical decision-making, equity in patient care, and workflow. We also discuss implications for medical ethics and patient autonomy. We provide suggestions for future research that will examine the impact of COVID-19 on OTP treatment and its patients, as well as the effect of making methadone take-home polices patient centered, all of which may foreshadow larger changes in the ways OTPs deliver their services.

Insights from a Jordan’s Principle Child First Initiative in Alberta

In 2016 Canada was ordered to implement Jordan’s Principle by the Canadian Human Rights Tribunal. In response to the order Canada created the Child First Initiative to provide federal funding for provincial and territorial organizations supporting First Nation’s children’s health, education, and social service needs, including service coordination. In the shifting national landscape of Child First Initiative funding, there is a lack of evidence on how pediatric healthcare services are addressing the serious health and healthcare inequities experienced by many First Nations children. This paper describes the implementation of a Child First Initiative by the First Nations Health Consortium in the Alberta region, and research findings that provide insights into the complexity and challenges of advancing First Nations children’s health and health equity within the current federal Child First Initiative mandate in this province. This paper highlights the need for transformative pediatric healthcare approaches that expand beyond an individual and demand-driven system and orient towards practices and policies that are socially-responsive. Also, that First Nations leaders and Jordan’s Principle initiatives play a leading role in the design and delivery of all pediatric healthcare services with First Nation communities, families and children across Canada.

Corporate disclosure in a voluntary reporting environment: NYSE-listed firms in 1900

This paper examines the financial reporting done by firms listed on the New York Stock Exchange in 1900 and the firm characteristics that determined what and how much firms would disclose. At this time, there were no federal disclosure mandates or stringent requirements imposed by the Exchange. Therefore, the reporting done by firms was largely voluntary and resulted in significant variation across companies and industries. I look at all 191 firms that listed stocks on the NYSE in this year and use data from Moody’s Manual of Industrial and Miscellaneous Securities and Poor’s Manual of the Railroads of the United States to determine the amount of financial disclosure. I find that more capital-intensive firms were more likely to report income statements and balance sheets and provided more volume of information. In addition, food, mining, and miscellaneous service firms disclosed the least. In addition, all else equal, the age of a company and offering preferred stock did not significantly increase its likelihood of reporting financial statements. Overall, the results indicate that even absent regulation, firms would voluntarily provide information but at varying degrees based on how much the company relies on outside investors and whether its industry is competitive. They also suggest that managers considered potential or explicit investor demand for financial information and responded to this demand.

Safe Firearm Storage: A Call for Research Informed by Firearm Stakeholders.

* Abbreviation: AAP — : American Academy of Pediatrics Firearm injury and mortality is a major public health concern that has taken a devastating toll on young Americans for decades. In 2018, 3335 young people (aged 1–19) died of firearm injuries, specifically homicide (55%), suicide (39%), and unintentional injury (3%).1 In a recent article, the Firearm Safety Among Children and Teens Consortium2 recommended increased attention to safe firearm storage in the home and other places (eg, cars) where individuals <18 years of age may have unauthorized access to prevent firearm injury and mortality, specifically suicide and unintentional injury. Such efforts draw on robust empirical findings that suggest that safer firearm storage will save lives.3 A simulation study revealed that a modest increase in safe firearm storage would result in a 32% decrease in lives lost.4 One setting ripe for delivering anticipatory guidance paired with safe storage devices, such as cable locks or lockboxes, is the pediatric health care setting. In this Pediatrics Perspectives, we offer suggestions for needed research to allow pediatric clinicians to offer recommendations that reflect effective and acceptable ways to safely store firearms to keep youth safe and that incorporate the voices of firearm stakeholders. What does it mean to store firearms safely from the perspective of parents and legal guardians (hereinafter referred to as parents) with children <18 years of age in the home? There is no universally agreed on recommendation that accounts for the nuanced reasons that parents own firearms. Specifically, major national organizations, depending on guild, offer different recommendations. The … Address correspondence to Rinad S. Beidas, PhD, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 3015, Philadelphia, PA 19107. E-mail: rbeidas{at}upenn.edu

To Sink or Swim: Evaluating Coastal Archaeological Stability through a System of Indices

ABSTRACT Archaeological resources in the coastal zone are subjected to a variety of cultural, social, and environmental conditions that affect a site’s stability, which can be defined in physical (e.g. structure, geophysical environment), sociocultural (e.g. looting, vandalism), and regulatory (e.g. federal, state, and local mandates) terms. To effectively manage resources within this dynamic environment requires a holistic understanding of what drives stability (or instability) at each site. The systematic development of indices for archaeological site stability aggregates a large number of complex conditions, both drivers and pressures, into a smaller set of key indicators that can be used to evaluate site stability, and to monitor changes over time. This system of indices provides an integrated framework for evaluation of site-specific stability that allows for adaptive management and the prioritisation of resources (e.g. funding, time, staff).

Our Water Future Requires Action Now

Key TakeawaysOur public health history is strong. The water sector did many of the right things at the right time to effectively protect public health, such as starting chlorination in the early 1900s.The status quo is not an option. We are collectively losing ground on new and emerging contaminants, funding, and public trust, to name a few of our major challenges.Water sector leadership at the local, state, and federal levels can change our trajectory and achieve a better future through coordination, collaboration, creativity, and speed.New regulatory and nonregulatory approaches are needed, such as optimizing the regulatory development process and looking outside of federal mandates for solutions.