Federal Requirements Research Articles

Clinician Perspectives on Barriers and Facilitators to Providing Medications for Opioid Use Disorder for Adolescents

Objectives: Despite rising adolescent opioid overdose deaths, adolescents under the age of 18 years are frequently excluded from the provision of medication for opioid use disorder (MOUD/OUD). As part of preimplementation work to inform the expansion of evidence-based practices to close this service gap, we designed this qualitative study to examine the perspectives of MOUD-providing clinicians on barriers and facilitators to providing MOUD for adolescents younger than 18. Methods: We recruited clinicians who reported prescribing MOUD at least once per month, purposively sampling to include individuals who varied on training and practice backgrounds, experience prescribing to adolescents younger than 18, and practice settings (urban, suburban, and rural). We performed semistructured interviews and subsequent qualitative thematic analysis of transcripts. Results: Three major barriers emerged: (1) the overcomplicated, intimidating nature of MOUD training and regulations, (2) poor understanding of MOUD treatment recommendations and consent/confidentiality laws for adolescents younger than 18, and (3) negative, stigmatizing views of adolescents with substance use disorders and the perceived difficulty of treating them. Facilitators identified included: (1) treatment demystification with adolescent-specific OUD implementation protocols/training, (2) clinician-to-clinician peer messaging and encouragement, and (3) formal family and community-level education medicalizing addiction. Conclusions: Significant barriers to prescribing MOUD to adolescents younger than 18 persist despite the removal of federal training requirements. Comprehensive, multilevel adolescent-specific MOUD education paired with may expand the MOUD-prescribing workforce and improve treatment access. Further research should continue to explore these themes to inform policy and practice reforms aimed at improving outcomes for adolescents affected by OUD.

Beyond Compliance: Secondary Teachers Navigate Tensions of Equity in Knowledge and Practice to Support Culturally and Linguistically Diverse Learners

ABSTRACTThis qualitative study examines how secondary teachers (6th–12th grade) navigated tensions of knowledge and practice while supporting culturally and linguistically diverse (CLD) students in a district with a history of not meeting federal requirements for serving English learners (ELs). Through the U.S. Department of Education's National Professional Development grant program, the teachers completed a master's degree in Educational Equity and Cultural Diversity and a Culturally and Linguistically Diverse Education (CLDE) endorsement. We use a critical sociocultural perspective to explore teachers' appropriation of knowledge during the first semester‐long graduate course as they grappled with new frameworks of multilingualism and advocacy rather than monolingualism and compliance. Findings illustrate how secondary teachers negotiate tensions that arise as they navigate conflicting district demands for student language and literacy development alongside emergent visions for more culturally and linguistically responsive instruction.

Exploring the Relationship Between Nursing Staff and Family Members' Appraisal of Resident Care in Nursing Homes: The Role of Facility Ownership.

Background/Objectives: To address long-standing staffing challenges and elevating care standards in the United States, new legislation will require a minimum of 0.55 h per resident day (HPRD) of registered nurse (RN) care, 2.45 HPRD of certified nursing aide (CNA) care, and a combined total of 3.48 HPRD across any combination of nursing staff. We examine differences in family members' views of care quality between facilities meeting the minimum staffing requirements and those that do not and whether there is any difference in those associations by facility ownership. Methods: This cross-sectional study utilized public data from 218 Medicare and Medicaid-certified nursing facilities in Maryland, collected in 2023. We used regression analyses to examine the association between staffing requirements and quality of care ratings, considering facility ownership status as a potential moderator. Results: Compared to facilities with CNA staffing levels below the cut off, facilities that met the CNA staffing requirement were rated more favorably by family members in overall quality and across the subdomains of staffing, care, activities, and security. In contrast, meeting the RN 0.55 cut off was not associated with family ratings across any quality domain. A facility for-profit status did not moderate the relationship between staffing and family ratings. Conclusions: These results suggest that CNA staff time is a significant driver of care quality and that non-profit facilities may already be closer to meeting new federal requirements. These findings highlight the need for regulations that support the minimum nursing staffing requirements to enhance care quality. Future research should identify the specific factors contributing to higher quality care in non-profit facilities and explore ways to implement these practices in for-profit settings.

Strengthening work requirements? Forecasting impacts of reforming cash assistance rules

AbstractWork requirements are perhaps the most controversial aspect of the Temporary Assistance for Needy Families (TANF) program, America's sole federal cash assistance program for low‐income families with children. In 2025, for the first time in nearly 20 years, the Fiscal Responsibility Act of 2023 (FRA) will implement policy changes intended to strengthen states’ work requirements. However, researchers’ and policymakers’ understanding of how FRA will impact states’ compliance with federal requirements is hampered by a lack of research and publicly available data. We tie information from reports submitted to the U.S. Department of Health and Human Services that we collected to administrative caseload and expenditure data to document several strategies that states currently use to comply with federal work requirements. We estimate that FRA will increase the stringency of work requirements in 23 states and that five states will begin to fall short of requirements. We note that several compliance strategies available to these states do not encourage work. We discuss changes to states’ work requirements that would promote better long‐term economic and labor market outcomes for TANF recipients.

INSIDE THE BLACK BOX OF MANAGED CARE: SERVING AT-RISK OLDER ADULTS IN MASSACHUSETTS’ SENIOR CARE OPTIONS PROGRAM

Abstract People dually eligible for Medicare and Medicaid are at risk for poorly coordinated care, high-cost health service utilization, and poor outcomes. Commonwealth Care Alliance (CCA), a not-for-profit managed care organization, serves approximately 35,000 people dually eligible for Medicare and Medicaid in the Commonwealth of Massachusetts. CCA has two primary products: Senior Care Options, which has served people 65 years or older since 2003, and One Care, which has served people 18-64 years of age since 2013. Drawing from key informant interviews and other data collection, this study sought to understand the organizational experience of the CCA model. It identifies the challenges CCA faces in ensuring that its vulnerable membership has access to both appropriate clinical care and the broad range of health-related services that are critical to the health of members. It also identifies the plan’s mechanisms for addressing these challenges. The evolution of CCA’s model of care and the various mechanisms it adopted over time to adapt to the needs of its membership and comply with state and federal requirements are discussed. These changes are then placed in the context of ongoing conversations about the most effective models of integrated care. Findings highlight CCA’s focus on health-related social needs; the impact of member advocacy on program design; and the implications of non-profit status for workplace culture and resources.

FEDERAL AND STATE POLICIES AND STAKEHOLDER VIEWS ON MEDICAID NURSING HOME PAYMENT

Abstract How much nursing homes (NHs) are paid by Medicaid is determined at the state level. Medicaid coverage of NH care is a significant expenditure for states. Consequently, states design Medicaid payment models to achieve desired policy objectives related to NH costs and quality, access to care, payment equity, service capacity, and budgetary control. Setting Medicaid payment rates too high can lead to excess profits at the expense of taxpayers with unknown implications to improvements in quality and staffing levels. At the same time, NHs need financial resources to pay nursing staff and invest in other quality improvement efforts to assure proper care. The industry claims that NH costs are not fully covered by their Medicaid payments. Consumer advocates argue that NHs are already adequately paid, and profit incentives potentially divert funds away from resident care. There is no federal requirement that Medicaid payments cover the full cost of care.

EXPLORING THE ASSOCIATION BETWEEN GOOGLE RATINGS AND NURSING HOME QUALITY

Abstract Online review platforms such as Google ratings have become a resource for consumers seeking nursing home (NH) care for their loved ones. As these ratings reflect subjective experiences, it is important to explore how they may correlate with the more rigorous and systematic measures of NH quality. The primary purpose of this study was to explore the association of Google ratings with NH deficiencies. This study is structured as a cross-sectional analysis (2018) utilizing the following datasets: Brown University’s LTC Focus, Ohio nursing home Google rating data, and Area Health Resource File. The dependent variable was deficiencies which reflect a facility’s failure to meet specified resident care standards, known as federal participation requirements (FPRs). Examples of deficiencies include a facility’s failure to adhere to infection control protocols or improper medication management. The independent variable was consumer reported Google ratings for Ohio NHs. We used negative binomial linear regression, adjusting for NH organizational (size, occupancy, ownership, chain affiliation, payer mix) and market factors at the county level (per capita income, urban/rural location) to assess the relationship. Mean Google rating was 3.55 out of 5 and mean total deficiency count was 11.98. We found that Google ratings were negatively associated with deficiencies (Incidence Rate Ratio=0.93, p< 0.05) (as the number of deficiencies increased, Google ratings declined). From a policy perspective, our findings highlight the need for regulatory frameworks to incorporate consumer feedback mechanisms in evaluating and improving nursing home care quality.

FILLING GAPS FOR OLDER OHIOANS WITH LOCALLY RAISED FUNDS

Abstract Most older Americans aging in place at home do not financially qualify for support through the Medicaid program, and funding provided through the Older Americans Act is insufficient. As a result, 15 states have turned to local revenue sources to fill service gaps for individuals living in the community, who require social care to support independence. Ohio has a long history of utilizing such funds, generating over $200 million, more than the other 14 states combined. Despite the demonstrated success of these programs, local levy programs in Ohio do experience an array of implementation challenges. This study conducted 15 qualitative descriptive interviews with 20 program officials from various locally funded levy programs across Ohio. Thematic analysis revealed barriers, including increasing state and federal eligibility requirements, staffing issues, rural access to resources, and challenges in setting reimbursement rates. These barriers are coupled with added pressure from county officials to move individuals onto state funded programs (e.g., Medicaid HCBS Waiver programs), rather than keeping them on locally funded programs. The aim of this paper is to examine challenges that local programs are facing and provide program and policy recommendations. Findings reveal the important role local levy programs play in addressing gaps in service and the importance of local advocacy and education to continue passing these levies. Increasing communication between levy staff across the state, integration of cross-funding streams allocated by the state and increasing reimbursement rates are needed to ensure the success of the local levy programs for the future.

A high FBR low SAR and AMC-backed compact wearable antenna array for WBAN applications

Abstract In this paper, a wearable antenna array based on a 9 × 3 artificial magnetic conductor (AMC) array is proposed with the characteristics of compact, low profile, low specific absorption rate (SAR), high front-to-back ratio (FBR) and high gain for wireless body area network (WBAN) bands. The proposed wearable antenna consists of a four-element array and an AMC array. The size of antenna array loaded AMC is 137.7 × 45.9 mm2. The dielectric substrate of the antenna and the AMC structure are made of 0.1 mm liquid crystal polymer material, which is flexible and low profiled. The antenna operates from 5.62 to 6 GHz after the AMC structure is loaded. The gain increases by 3.23 dB, reaching 12.03 dB at 5.8 GHz. And the FBR value is raised by 26.04 dB. The highest SAR value of the simulated antenna on the human model is 0.0496 W/kg, far less than the US federal or EU requirements. After constructing and testing the antenna, the outcomes of the tests agreed with the results of the simulation. The flexible antenna array with AMC structure has good prospect in WBAN applications.

"We're Preventing People From Going Into the Most Expensive Level of Care in Every Way that We Can": Barriers and Recommendations for Use of Local Funds.

Most older Americans do not financially qualify for Medicaid and support provided through the Older Americans Act is quite limited. In response, Ohio has generated funds for services for older adults through the use of local county tax levy programs. Ohio currently leads the nation in the utilization and support of local levy funding, generating more than US$200 million annually. This study conducted qualitative descriptive interviews with 15 locally funded programs across the state. Thematic analysis revealed that local programs encounter an array of implementation barriers, including increased state and federal eligibility requirements, staffing issues, lack of access to services in rural locations, and low reimbursement rates. These barriers are coupled with added pressure from county officials to move individuals onto state-funded programs, rather than locally funded programs. This paper also provides recommendations for how these programs can be better supported to ensure their sustainability for the future.

Interorganizational systems without hierarchy: immunization information systems

PurposeThe 2020–2021 COVID-19 pandemic spurred change across multiple healthcare industries. This study explores how managing vaccination data in the United States of America required cooperation among many different organizations necessitated by an emergency response. We studied how individual states interacted with the federal government to address the need for vaccination-related information during the pandemic.Design/methodology/approachIn total, 11 interviews were conducted with individuals responsible for collecting vaccination data and reporting it to the US Federal Government. Seven of those individuals were directors of USA jurisdictional Immunization Information Systems (IIS). Archival data were also combined with the interview responses to inform the analysis and development of guidelines.FindingsStates across the USA had different ways of tracking and storing immunization data that was heavily influenced by state-level and federal legislation. The lack of a universal patient identifier made cross-state patient identification difficult. Federal requirements for reporting dictated much of how the different state-level entities collected, stored and reported data.Practical implicationsThis study highlights the importance of data interoperability and data sharing by exploring how a loosely coupled set of entities without direct top-down control or a profit motive can govern data effectively. Our analysis provides greater clarity about the interactions between different stakeholders in a complex system.Originality/valueThis study presents primary interviews of 11 individuals, each responsible for tracking and reporting immunization information. Analysis of the data expands existing research on IIS on data sharing, system interoperability and dynamic pandemic responses.

Detection of equine parvovirus-hepatitis and efficacy of governmental regulation for equine biologics purity.

In 2018, a new virus, named equine parvovirus-hepatitis (EqPV-H), was discovered in a biologic product that had been administered to horses that subsequently developed clinical signs of equine serum hepatitis (Theiler disease). Further correlation of the virus with the disease sparked federal requirements that all equine biologics be free of EqPV-H. The initial quantitative real-time PCR (qPCR) test for EqPV-H has proved to be sensitive to co-extracted PCR inhibitors in template nucleic acids, causing false-negative results. We investigated the use of digital PCR (dPCR) as a more robust test. Examination of 227 equine biologic product lots available for purchase both before and after regulatory implementation using both detection methods indicated that dPCR is a more reliable platform. Nevertheless, use of the qPCR method for product screening had reduced the fraction of serials with EqPV-H detected from 39.6% prior to regulation to 6.8% after regulatory implementation. Adoption of dPCR testing is an opportunity to further decrease the prevalence of EqPV-H in equine biologics.

A Review of the Lawrence Livermore Nuclear Accident Dosimeter 1980s-present

A Review of the Lawrence Livermore Nuclear Accident Dosimeter 1980s-present

Factors affecting problem-solving court team decisions about medications for opioid use disorder

Factors affecting problem-solving court team decisions about medications for opioid use disorder

Language Barriers in School Health: Addressing Health Equity in the U.S. Educational System.

Federal law requires school health leaders to ensure meaningful access to language resources to promote optimal health and education outcomes. This paper aims to inform all stakeholders, including decision-makers, about the importance of developing language access plans and policies. Multiple sources and legal guidelines provide a comprehensive overview of the issue. Including an examination of current practices and challenges that school nurses encounter, specifically regarding language resources, guidance is offered to elucidate meaningful language access policies that ensure equitable access to school health services. Supporting meaningful language access includes providing school nurses with qualified interpretation and translation services to care for those who do not speak, read, or write in English or have limitations with the English language. Additionally, local and state agencies may implement language access services requirements and enforce compliance with a language access plan to meet federal funding requirements.

The problem of the legal status of persons replacing public offices of the subjects of the Russian Federation

The article describes a comprehensive study of the problem of the legal status of persons replacing public offices of the subjects of the Russian Federation. The gaps in the legal regulation of the status of persons replacing public office holders at the regional level are identified. Attention is drawn to the lack of unified federal requirements both when appointing persons and when they carry out their activities. The necessity of development of a unified legal mechanism at the federal level is established.

High-tech industry development: selection of technology parks operation model elements in the field of high technology

The article presents the justification of model elements choice for technology parks work in the sphere of high technologies in Russia. The methodology for creating the model, which was built on the position of borrowing the best practices of existing models of innovation infrastructure facilities operation and functioning in the country, has been given. It has been proposed to form a rating among operating technology parks, within the framework of which a comprehensive assessment of technology park management companies’ performance has been carried out according to four groups of indicators (sub-indexes) such as subjects investment attractiveness, information openness, technology parks internal ecosystem, and management company efficiency. Based on the rating results, the leaders among technology parks have been identified, and their behavioral models adopted as reference metrics for the model to be developed. Based on the leaders’ position, it has been proposed to choose the best technology parks model in the field of high technologies in terms of their interaction with residents. Recommendations have been presented for the technology parks infrastructural model as the most promising for private companies, while investment projects should be developed considering federal requirements and standards to ensure their successful implementation and achievement of the set goals. Technology parks in the sphere of high technologies play a key role in Russian economy development. They contribute to the development of innovations, new technologies, high-tech industries, and knowledge-intensive business. It is important that such technology parks development is optimally organized with due regard to modern requirements and regulatory measures.

Innovative pedagogical technologies in the modernization teaching of morphological disciplines

This article describes the experience of using innovative pedagogical technologies in the teaching process of morphologic disciplines. The need for such modernization associated with approval of the Federal State educational standards and requirements for building the necessary set of competencies for the future doctor. Application of innovative pedagogical Technologies expands the possibilities of preparing students for the newer forms of external audit of the residual knowledge of students, develops clinical thinking, more successfully prepares for upcoming Professional activity.

Perspectives on using Protected Species Observer (PSO) data to fill knowledge gaps about marine species distributions and habitat use

Abstract Responsible offshore wind energy development requires addressing knowledge gaps of marine mammal distribution and response to wind energy development. Data collected by Protected Species Observers (PSOs) could help fill these gaps if they were used to fit species distribution models. However, because PSO data are not systematically collected, a critical exploration of their potential utility is needed. We reviewed PSO data collected during offshore wind geophysical surveys. Our intention was to compare predictions from two species distribution models—one model fit with systematically collected data and the second model fit with PSO data. However, developing a model using the PSO data was impossible due to data collection and reporting procedures. Therefore, we reframed our question to “What changes would be necessary for PSO data to be used to understand species distributions?” We compared PSO data with data collection fields recommended by US federal agencies and data collection requirements in Marine Mammal Protection Act Incidental Harassment Authorizations. We found PSO data collection fields and monitoring reports need standardization requirements. Our evaluation of PSO data revealed that publicly available PSO data are limited. We recommend making PSO data publicly available. If these recommendations are adopted, PSO data could help to fill knowledge gaps about marine mammal distribution.

The Present State of Housing and Treatment of Transgender Incarcerated Persons.

The care and housing of transgender (TGD) incarcerated persons is a complex concern that is growing because of the increased recognition and diagnosis of gender dysphoria in society. To remain current in this evolving landscape, there have been updates to federal manuals and state guidelines regarding the medical care and housing of the TGD population. Since the publication by Glezer and colleagues in 2013, there has not been a comprehensive overview of current federal and state guidelines, and legal and other considerations on this topic. We provide an update with special consideration given to housing practices, safety, and access to care. A review of the literature shows that the World Professional Association for Transgender Health (WPATH) standards and Prison Rape Elimination Act (PREA) requirements are not uniformly implemented and enforced on a state level. In fact, some states have policies that are in direct conflict with federal requirements. The safety and equitable treatment of both TGD and cisgender populations is an important topic that merits attention. As new challenges emerge, an increase in federal enforcement and consistency is needed to ensure the humane treatment and protection of TGD inmates.