Pending Legislation Research Articles

Meeting Mandatory Infectious Disease Reporting Requirements: The Department of Veterans Affairs' Plan

In response to pending legislation, the Department of Veterans Affairs (VA) recently issued a new Directive that requires mandatory reporting of infectious diseases to public health authorities. One potential implementation strategy is to use the VA's Healthcare Acquired Infection and Influenza Surveillance System - an electronic biosurveillance system that will soon be released nationally - which would not only build on existing technology, optimize reporting, and minimize work burdens on VA staff but also allow the VA to comply with Meaningful Use requirements.

Twenty-First-Century Debt Collectors: Idle No More Combats a Five-Hundred-Year-Old Debt

Self-determination. Survival. Sovereignty. These are the principles driving the No More movement and the ideas that have consistently driven Indigenous peoples in North America to fight against their colonizers' destructive designs on their bodies, lands, and spirits. From the genocidal actions of Manifest Destiny and residential boarding schools to Sand Creek, Wounded Knee, and reservations, the governments of the United States and Canada have persistently colonized the Indigenous peoples of this continent in word and deed. No More is an ongoing grassroots effort created by four First Nations women in Canada that has attracted global attention and support. On its website, the group calls for the repeal of provisions in Bill C-45, which became law in 2013, (including changes to the Indian Act and Navigable Waters Act, which infringe on environmental protections, Aboriginal and Treaty rights) and abandon pending legislation which does the same. In cooperation with Defenders of the Land, this growing Indigenous network also calls on Canada to increase proportional representation with regard to all legislation concerning collective rights and environmental protections; to live up to the United Nations Declaration on the Rights of Indigenous Peoples and to respect the right of Indigenous peoples to say no to development on their territory; and to officially repudiate the racist Doctrine of Discovery and the Doctrine of Terra Nullius and abandon their use to justify the seizure of Indigenous Nations' lands and wealth (Idle No More 2013). The of No More seems simple: Idle No More calls on people to join in a peaceful revolution, to honour Indigenous sovereignty, and to protect the land and water. However, peaceful revolution is a complicated goal that requires an understanding of why these women were motivated to act in November 2012.Indigenous women lead their communities with visionary leadership skills; deep cultural knowledge; and a central focus on spiritual faith, honesty, and integrity. As they have since before the European invasion, Indigenous women are responsible for the health of their communities and have always taken this role seriously. Under continued assault from external and male-dominated political forces, such as the Indian Act, Indigenous women need to possess and exercise forms of political empowerment to maintain and improve the day-to-day lives of their people. No More presents an Indigenous vision of politics that surpasses the control that state sovereignty has over contemporary Aboriginal life. The women leading No More are twenty-first-century debt collectors who have created an attention-grabbing model for decolonial Indigenous feminism that builds upon a rich history of Indigenous resistance to colonial control over land, culture, and lives: a movement that empowers Indigenous women on the path to achieving social justice for Indigenous nations. As other contemporary movements respond and react to injustice and the trampling of rights through street protests and occupation of public spaces, the No More movement is trying to shift the contemporary discourses of rights, sovereignty, and nationhood by arguing that it is Indigenous women who ought to ultimately hold the political power of Indigenous nations, or at the very least have an equal seat at the debate table. According to Leanne Simpson in Dancing on Our Turtle's Back: Stories of Nishnaabeg Re-creation, Resurgence and a New Emergence, Western-based social movement theory has failed to recognize the broader contextualizations of resistance within Indigenous thought, while also ignoring the contestation of as a starting point Part of being Indigenous in the 21st century is that regardless of where or how we have grown up, we've been bathed in a vat of cognitive imperialism, perpetuating the idea that Indigenous Peoples were not, and are not, thinking peoples-an insidious mechanism to promote neo-assimilation and obfuscate the historic atrocities of colonialism (2011,32). …

An Overview of Pending Asylum and Refugee Legislation in the US Congress

There has been no significant legislation related to the asylum process enacted in Congress in nearly a decade. In 1996, the Illegal Immigration Reform and Immigration Responsibility Act (IIRIRA) became law, rolling back protections for asylum seekers by including a one-year deadline for filing asylum applications, subjecting asylum seekers to “expedited removal” procedures, and expanding the detention of asylum seekers. In 2005, Congress enacted the REAL ID Act, which created additional legal barriers to asylum, including new requirements for proving an asylum claim. During the past several sessions of Congress, bills have been introduced that would make significant changes to the country’s asylum laws and refugee admissions program. This paper provides an overview of the pending legislation and the changes proposed. This overview is instructive in understanding (1) which members of Congress have demonstrated interest and leadership in refugee and asylum issues; (2) which refugee and asylum reform issues have been of most interest to members of Congress in recent years; (3) the different approaches to refugee and asylum issues by members of Congress who have shown leadership on these issues; and (4) which provisions have been enacted, which have gained traction, and which remain pending without significant movement through the legislative process. While it is difficult to imagine in the current partisan climate how any asylum or refugee legislation could be enacted into law, some legislative provisions have been reintroduced over a number of sessions of Congress and some have a history of bipartisan support. Legislation focused on a group of particular interest or concern to members of Congress could gain traction. A more comprehensive legislative approach framed by the need generally to improve the system could be less effective, particularly in the context of the years-long stalemate on comprehensive immigration reform. While legislation is unlikely to pass in the near future, it remains important for members of Congress who believe in the importance a fair, effective, and humane asylum system and refugee resettlement program, to introduce and build support for asylum and refugee legislation. Provisions in bills that have already been introduced, like those in S. 744, are more likely to be included in legislation that is moving through Congress. In addition, these bills demonstrate the continued interest of members of Congress in asylum and refugee issues and the need for reform. They also provide an important tool for advocates for education and outreach to Congress and the public.

Delivering colonoscopy screening for low‐income populations in Suffolk County

Current and pending legislation provides colorectal cancer screening reimbursement for previously uninsured populations. Colonoscopy is currently the screening method most frequently recommended by physicians for insured patients. The experience of the SCOPE (Suffolk County Preventive Endoscopy) demonstration project (Project SCOPE) at Stony Brook University Medical Center provides a model for delivering colonoscopy screening to low-income populations to meet anticipated increasing demands. Project SCOPE, based in the Department of Preventive Medicine, featured internal collaboration with the academic medical center's large gastroenterology practice and external collaboration with the Suffolk County Department of Health Services' network of community health centers. Colonoscopies were performed by faculty gastroenterologists or supervised fellows. Measures of colonoscopy performance were compared with quality indicators and differences between faculty and supervised fellows were identified. During a 40-month screening period, 800 initial colonoscopies were performed. Approximately 21% of women screened were found to have adenomatous polyps compared with 36% of men. Five cancers were detected. The majority of the population screened (70%) were members of minority populations. African American individuals had a higher percentage of proximally located adenomas (78%) compared with white individuals (65%) and Hispanics (49%), based on the location of the most advanced lesion. Hispanic individuals had a 36% lower risk of adenomas compared with white individuals. Performance measures including the percentage of procedures with adequate bowel preparation, cecum reached, scope withdrawal time, and adenoma detection rate met quality benchmarks when performed by either faculty or supervised fellows. Project SCOPE's operational strategies demonstrated a feasible method for an academic medical center to provide high-quality screening colonoscopy for low-income populations.

State and Local Pension Fund Governance and the Process of Contracting for Investment Services

US state and local public employee retirement systems (PERS) utilise various models of contract with distinctive features in their form and substantive content in relation to industry norms. These models differ between states, within states, and even between PERS within major metropolitan areas. Diversity goes against expectations to the effect that the sector relies upon commonly accepted investment management agreements (IMAs), given the similarities between state and local PERS as to their governance and the nature of pension benefits. One goal of this paper is to account for apparent commonalities and differences. Another goal of the paper is to explain the nature and significance of the pre-contract screening of potential suppliers to the sector, suggesting that requests for proposals tend to “sterilise” contracts for investment management services. We provide a comparison of the categories and items evident in the model IMAs with reference to selected states, in particular Illinois and the Chicago-area PERS. We also briefly note relevant provisions of pending legislation establishing the Oregon Investment Corporation, emphasizing provisions which would enable the fund to make contracts like its private sector peers. The paper concludes that it is important to focus on the process of contracting in US state and local PERS as well as the form of contract.

Adopting the Stateless

Statelessness, the lack of legally recognized citizenship, affects twelve million people worldwide. The consequences of statelessness frequently lead to compounding human rights abuses, including human trafficking, oppression, and neglect. Few solutions exist for statelessness absent compelled citizenship recognition in a nation state. Coincidentally, inter-adoption is growing in demand, but contracting in available sending states. This article proposes a nexus of statelessness and intercountry adoption where legislation is put forward to adopt stateless individuals, particularly children. This article will analyze pending legislation for the adoption of North Korean stateless persons and recommend legislation to address broader issues of statelessness.

Speaking of Science: Introducing Notice-and-Comment into the Legislative Process

Congress enacts, on a nearly continuous basis, a variety of laws that affect scientific research and progress. Some of these laws have an unquestionably positive effect. For instance, Congress’s creation of the National Institutes of Health, the National Academy of Sciences, and NASA; its various appropriations to fund ground-breaking research; and a multitude of other laws have incalculably advanced human knowledge, and it is to Congress’s great credit that these laws have been and are continuing to be enacted. However, not all laws that affect the progress of sciences are an unalloyed good. Quite the opposite, often the laws aim to, and in fact do, retard the progress of scientific research. The question is then whether the benefit from those laws outweighs the costs imposed on scientific progress.Congress, however, often does not fully consider the costs that the legislation imposes on science, either for lack of information or as a result of conscious disregard for the views of a politically insignificant group. The public is not able to hold Congress accountable because it lacks an ability to participate in the process and lacks an objective basis against which to measure congressional action. The problem is not congressional malfeasance or ignorance but rather the structure of the legislative process itself. The general public is often taught and told that lawmaking is a process that begins in a committee where the proposal is carefully studied, debated, amended, and voted on. The reality, of course, is much different. First, bills often skip the committee process, and amendments are often added last minute without a chance for a meaningful debate. But even where the process is followed, it is often hard to portray the committee hearings as a true deliberative process. Instead, they are often described as a Kabuki theater, where the Chair and the Ranking Member designate the witnesses they wish to call to support the preformulated position. Interested parties cannot provide testimony unless asked to do so by the relevant committee. Thus, oftentimes the people with the deepest knowledge, but low political skills, are cut out of the process. The end result is that Congress votes on legislation without fully understanding the implication thereof. The voters also are injured in that it is hard to hold Congress accountable if one cannot point out that it ignored the views of the scientific communities.This Article proposes a solution to the problem. Bills that affect the progress of science ought to be evaluated by an independent body similar to the Congressional Budget Office. Like the CBO, this body would not have any authority to block a bill, but it would be able to “score” it (i.e., provide information on the effect the bill will have on research). In order to accomplish its task, this newly created body would be required to provide notice of pending legislation and then seek comments from the interested parties, much like what is done in the administrative rulemaking process. The comments then would be collected and analyzed, and the final report would be presented to Congress before it votes. Congress would continue to be able to vote as it pleases, but with this process in place, it would be forced to do so with its eyes wide open. By understanding the full scope and the implication for the scientific progress of the bills it wishes to enact, Congress would produce better legislation, which would be less detrimental to the scientific progress.

An Overview of State Anti-Bullying Legislation and Other Related Laws

As a part of its collaboration with the Born This Way Foundation, the Berkman Center is publishing a series of papers that synthesize existing peer-reviewed research or equivalent scholarship and provide research-grounded insight to the variety of stakeholders working on issues related to youth empowerment and action towards creating a kinder, braver world. This series, called the The Kinder & Braver World Project: Research Series (Danah Boyd and John Palfrey, editors), is presented by the Born This Way Foundation & the Berkman Center for Internet and Society at Harvard University, and supported by the John D. & Catherine T. MacArthur Foundation. The first set of papers, which were intended to provide insights to the new foundation, involved topics related to Youth Meanness and Cruelty.This document provides an overview, as of January 2012, of existing state anti-bullying laws, pending state and federal anti-bullying legislation, and other relevant federal and state laws. It is meant to inform the discussion of legal policy issues around bullying, in particular at the Symposium on Youth Meanness and Cruelty being held at Harvard Law School on February 29, 2012 as part of the Kinder & Braver World Project.This document, including the Tables in Appendix 1, was created by analyzing the anti-bullying laws of the 48 states with such laws, as well as reviewing pending legislation and related laws. The document and tables break out provisions of the state statutes that the authors consider important to engender positive cross-disciplinary discussion at the Symposium. The language in the state statutes is incredibly varied and complex, and this area of the law is constantly evolving. Many additional areas of inquiry are sure to arise at the Symposium and beyond. Thus, this document is a working draft.

Advanced Practice Nursing Scope of Practice for Hospitals, Acute Care/Critical Care, and Ambulatory Care Settings

Advanced Practice Nursing Scope of Practice for Hospitals, Acute Care/Critical Care, and Ambulatory Care Settings

Advanced Practice Nursing Scope of Practice for Hospitals, Acute Care/Critical Care, and Ambulatory Care Settings: A Primer for Clinicians, Executives, and Preceptors

Advanced Practice Nursing Scope of Practice for Hospitals, Acute Care/Critical Care, and Ambulatory Care Settings: A Primer for Clinicians, Executives, and Preceptors

Preparation of biodegradable polymer materials using agricultural waste

Polymer materials such as plastics, synthetic fibers and rubbers play an increasingly important role in our everyday lives. Most widely used polymeric materials developed in the past 50-60 years are durable and inert in the presence of microbes thus leading to a long term performance. However, in view of the current emphasis on environmental pollution problems and in conjunction with the land shortage problems for solid waste management and pending legislation, the need for biodegradable and „environmentally friendly‟ polymers came up. There are a number of applications (packaging, agriculture, household use, and more) where biodegradable polymers and composites are particularly suitable as sustainable alternatives. The aim of this study was to prepare a biodegradable polymer material using agricultural waste. Rice straw is one of the main cereal straws and is produced in large quantities in Sri Lanka. Rice straw was used as a main ingredient in this research to prepare the biodegradable polymer material. At present, these waste streams are not economically re-used and will create even larger problems for air and surface water pollution and having therefore a negative effect on people and planet.Rice straw which was an abundant biomass also consists of cellulose, hemicelluloses, lignin and others such as ash extractives and wax. Approximately 80% of yield of cellulose - hemicelluloses mixtures were extracted from rice straw using alkali extraction methods. Extracted products were identified and characterized by using Fourier Transform Infrared Spectroscopy (FTIR). Biodegradable polymer material was prepared by using Low Density Polyethylene (LDPE) and cellulose – hemicelluloses mixtures. Products were prepared by varying cellulose – hemicelluloses concentration. Biodegradable polymer mixtures were prepared by using laboratory scale internal mixture. Hydraulic press was used to prepare the LDPE - cellulose – hemicelluloses polymer products.Degree of biodegradability of the developed LDPE - cellulose – hemicelluloses product was measured by using soil burial test. Time dependent stress and strain properties were evaluated by tensile test. Water absorption test was also performed to evaluate the degradability. Weight loss gradually increased in all cellulose – hemicelluloses containing samples with increase of time in soil burial test. Water absorption test results also showed similar pattern. Tensile strength and percentage elongation of LDPE – cellulose –hemicelluloses product gradually reduced with the time in the soil burial test. This study suggests that rice straw has a good potential in obtaining cellulose and hemicelluloses to prepare biodegradable polymer materials for different applications. Key words: LDPE, biodegradable, cellulose, hemicelluloses

Comparative analysis of state-level concussion legislation and review of current practices in concussion

Forty-two states and the District of Columbia have passed legislation based on the Lystedt law of Washington state, enacted in 2009 to protect young athletes who have sustained a concussion. The aim of this study was to note the several similarities and differences among the various laws. Concussion legislation was compared for 50 states and the District of Columbia. Evaluation parameters of this study included stipulations of concussion education, criteria for removal from play, requirements for evaluation and return to play after concussion, and individuals required to assess young athletes. Other parameters that were not consistent across states were also noted. Forty-three states and the District of Columbia have passed concussion legislation, and an additional 4 states have pending legislation. All states with existing legislation support concussion education for coaches; however, only 48% require coaches to undergo formal education. Athletes must be educated on concussion in 86% of states and parents in 88.7%. Suspicion of concussion is a criterion for removal from play in 75% of states; signs and symptoms of concussion are criteria for removal from play in 16% of states. The individuals allowed to evaluate and clear an athlete for return to play differ greatly among states. Injury prevention legislation holds historical precedent, and given the increasing attention to long-term sequelae of repeated head trauma and concussion, concussion legislation has been rapidly passed in 43 states and the District of Columbia. Although the exact stipulations of these laws vary among states, the overall theme is to increase recognition of concussion in young athletes and ensure that they are appropriately cleared for return to play after concussion.

Active or Passive: The Role of a New Jersey Health Insurance Exchange

Health insurance exchanges are intended to organize the health insurance marketplace for the benefit of individuals and small businesses, a marketplace that many find confusing and increasingly expensive. New Jersey has two decades of experience with efforts to bring efficiency and transparency to this market. The Affordable Care Act (“ACA”) envisions Exchanges with powers and duties that go beyond New Jersey’s existing Individual Health Coverage Program and Small Employer Health Benefits Program. How much further the Exchange’s powers and duties ought to go is politically and practically contested. In particular, there is sharp dispute in New Jersey and elsewhere over the degree to which Exchanges should be active purchasers, directly bargaining with carriers to give consumers the bargaining clout enjoyed by large employers, or open marketplaces, arming consumers and small businesses with information to empower them to choose from among the array of products offered by willing insurers.This Brief will provide information and analysis to help assess the costs and benefits of New Jersey’s options. It will describe time frames for decision, and the options for New Jersey to build its own Exchange, leave the task to the federal government, or act in partnership with the federal government. It will describe past and pending New Jersey legislation and gubernatorial response, and decisions made in other states grappling with the role of their Exchange. After the Supreme Court’s decision largely upholding the ACA and the reintroduction of the Exchange bill in the New Jersey Legislature, the issue of New Jersey’s Exchange is back on the public agenda.There are four domains of tasks for which the Exchange will be responsible; within each domain are tasks that the ACA requires, and tasks that New Jersey can assign to the Exchange at its option. The four domains are: 1) Information: providing or facilitating the provision of coverage information to consumers through hotlines, on-line calculators, and Navigator services. 2) Eligibility and enrollment: facilitating or accomplishing the enrollment and reenrollment of consumers in public and private insurance plans. 3) Financial management: maintaining a self-sustaining income stream, maintaining accurate accounting of activities, granting exemption from individual responsibility for coverage, and assessing and transferring to the Secretary of the Treasury information on individual exemptions and employers whose employees were eligible for an unaffordability exemption or a tax credit because the employer did not provide minimum essential coverage. 4) Private plan selection and management: screening plans in and out of the Exchange market, and overseeing the activities of Exchange plans.

Regulating The Use Of Prescription Drug Databases In Health Insurance Underwriting

<span style="font-family: Times New Roman; font-size: small;"> </span><p style="margin: 0in 0.5in 0pt; text-align: justify; mso-pagination: none;" class="MsoNormal"><span style="font-size: 10pt;"><span style="font-family: Times New Roman;">This paper examines the use of commercially-available prescription drug profiles in the underwriting of individual and small-group health insurance plans.<span style="mso-spacerun: yes;"> </span>It explains how these profiles are developed and used by insurers and analyzes their potential advantages and disadvantages to both insurers and consumers.<span style="mso-spacerun: yes;"> </span>Current and pending legislation and regulations governing the use of these prescription databases are also explained.</span></span></p><span style="font-family: Times New Roman; font-size: small;"> </span>

The Honorable Arlene Wohlgemuth and the Texas Public Policy Foundation

The Texas Public Policy Foundation is a nonprofit, nonpartisan research organization providing credible and valuable information that nurses can use in their pursuits to influence health care policy. The information is rich and is produced in such a way that the general public can understand the issues as well as the impact of pending and future legislation. The Foundation's publications are excellent resources for nurses practicing in Texas and around the nation. As the Director of the Center for Health Care Policy at the Foundation, Arlene Wohlgemuth is an accessible and approachable resource and friend to nurses.

America's Drug Problem

AbstractAmerica has a serious drug problem. The problem is not abuse of prescription stimulants by students cramming for the SATs, nor is it the recent spate of violent attacks associated with the use of so‐called bath salts. Rather, the problem is a shortage of critical medicines. The American Society of Health System Pharmacists reports that over two hundred drugs are in short supply. The frequency and number of drug shortages are also increasing steadily, as seen in a recent Food and Drug Administration study that found that the number of reported drug shortages has nearly tripled, from sixty‐two in 2005 to 178 in 2010. There are few quick solutions to the crisis, and the long‐term effect of pending legislation and regulatory changes is unclear.

The Retreat From Advanced Care Planning

THE SPECTER OF DEATH PANELS LIVES. 1 AS A REMINDER of their origin, the House of Representatives version of what eventually became the Affordable Care Act (ie, the health care reform bill passed in 2010) included a provision authorizing Medicare to reimburse physicians for the time they spend discussing with patients their goals and preferences surrounding end-of-life care. “Advanced care planning” is the term used for the process of patients’ thinking about and communicating their values and preferences, whereas the term “advanced directive” refers to the related legal document. The advanced care planning process helps ensure that individuals receive the health care they desire at the end of their lives. The provision had widespread bipartisan support until the summer of 2009, when Sarah Palin morphed talk of providing support for patients who wanted to have a discussion with their physicians concerning their priorities into rhetoric alluding to “death panels.” The provision was removed from the pending legislation in reaction to the ensuing maelstrom. In the fall of 2010, voluntary advanced care planning was included in the draft regulation covering the new annual wellness visit that provides Medicare coverage for preventive services that have a compelling evidence base. Evidence shows that patients who talk with their physicians about their preferences for end-of-life care felt they had more ability to influence their medical care, believed their physicians had a better understanding of their wishes, and indicated a greater understanding and comfort level than they had before the discussion. Families also reported less stress after the patients died. The public comments on the draft of the annual wellness visit including advanced care planning were positive. But media commentators again discovered the issue, and the controversy was rekindled. Despite the positive public comments and the compelling evidence base that advanced care planning improves patient-centered care, provision for advanced care planning was removed from the annual wellness visit, presumably at the behest of members of the administration. Over the past year, the Centers for Medicare & Medicaid Services (CMS) has published several additional rules and regulations including new payment rules and the Hospital Conditions of Participation, the conditions that hospitals must meet to participate in the Medicare and Medicaid programs. None of these rules or regulations included mention of voluntary advanced care planning. Given the support of CMS for patient-centered care and value-based purchasing, it was reasonable to expect that advanced care planning–related measures would be included in at least some of the new CMS rules, regulations, and programs. Their absence is notable. Almost 2 and a half million people in the United States die every year, making death the most common health event in the United States. Clinical decision-making predicated on meeting an individual’s health priorities is the cornerstone of patient-centered care. When faced with advanced illness and the end of life, patients vary in what care and outcomes they prioritize. Some want aggressive treatment focused on prolonging life as long as possible; others want care focused on comfort, function, and quality of life. Patientcentered care dictates that physicians offer care consistent with the individual priorities and preferences of patients. Physicians cannot provide care consistent with patient wishes, goals, and priorities, however, if they do not know them. Even without CMS provisions covering advance care planning, physicians are not prohibited from engaging in advanced care planning discussions with their patients. Media misrepresentation and the absence of endorsement of advance care planning by the administration and CMS, nevertheless, affects the relationship between physicians and patients. The administration’s acquiescence, as much as the “death panel” falsehood, compromises the openness and trust between patient and physician that is needed to elicit patients’ priorities and preferences. By not forcefully reacting to the misleading statements, the administration has unwittingly created an aura of doubt. By its unwillingness to make the case for the centrality of advanced care planning to health care, the administration lends credence to the no-

Insecurity and Economic Inequality in the United States

In recent memory, the United States has lived under a heightened sense of insecurity. This sense of insecurity, which initially emanated from the terrorist attacks in September 2001, subsequently has been extended to the employment and financial sectors. As a response to terrorism, multiple Congressional laws have put added restrictions on the movement of humans, capital, and goods and services. On the whole, such policy changes have contributed to a climate of securitization of the major areas of American life. The sense of insecurity has been correlated with a level of economic inequality previously unseen in American history. It is argued that to address both issues simultaneously, the United States should foster improved relations with both Mexico and Canada. The pending legislation in the US Congress on comprehensive immigration reform may hold one of the keys to addressing the problems of both insecurity and inequality in a meaningful way.

Worldviews and discursive construction of GMO-related risk perceptions in Turkey

This paper analyses the discursive construction of the genetically modified organisms (GMOs) issue in the Turkish political arena following the public debate on the pending legislation on biosecurity. The study proposes an operational approach to semiotic/actor network theory (Latour) applied to public representations of a new technology within the theoretical frameworks of social representation theory and cultural theory of risks. It aims to highlight how different worldviews produce different risk discourses of GMOs in Turkey. Using cluster analysis to inductively extract evaluative categories, we use these to identify themes by human coding. Lastly, we apply formal concept analysis to link themes to actors and their worldviews, establishing their semantic networks. Formal concept analysis revealed four discourse networks reflecting nationalist, Islamist, progressive (left) and neo-liberal worldviews. Finally, these structures will be grounded back in the articles for a richer interpretive analysis.

AMDA Briefs Congress on Observation Stays

On Oct. 20, Eric Tangalos, MD, CMD, of the Mayo Clinic in Rochester, Minn., told a congressional briefing that observation time in a hospital should count toward the 3-day inpatient eligibility requirement for coverage of skilled nursing facility services under Medicare. “AMDA has been an advocate to eliminate the mandatory 3-day hospital requirement in order to qualify for post-hospital extended care service payments since my freshman days as AMDA's delegate to the American Medical Association [AMA],” Dr. Tangalos said at the session on Capitol Hill. “We made this an AMDA priority in 1991 and have been working with the AMA since 1993 to provide skilled services to nursing home patients without [their] first having to be admitted to the hospital,” he said. “We now have the opportunity with congressional legislation to at least allow the time patients spend in hospital ‘observation’ to count toward the 3-day qualifying stay.” Medicare beneficiaries spoke during the first half of the briefing. Dr. Tangalos spoke on the second panel with Gail Sheridan, vice president of health care services at Minnesota-based Tealwood Care Centers, who spoke on behalf of the American Health Care Association. She said that patients in observation may not realize it, nor do they know that being in observation can preclude them from getting appropriate nursing home care. Patients and their families deserve clarity in this, Ms. Sheridan said. Dr. Tangalos recounted that AMDA's House of Delegates passed a position affirming its opposition to the Medicare 3-day acute care hospitalization requirement for SNF eligibility in 1993. This AMDA position was later passed as policy by the AMA House of Delegates. In 2008, AMDA expanded its policy to urge the CMS to allow observation-bed and emergency room observation times as counting toward the 3-day-stay requirement. In August 2010, AMDA was represented at the Centers for Medicare & Medicaid Services Listening Session regarding the trends of Medicare beneficiaries receiving extended observation care as hospital outpatients. In written comments to the agency, AMDA urged the CMS to include observation-bed status and emergency room observation time as part of the mandatory 3-day inpatient hospital stay required for the Medicare SNF benefit. AMDA strongly supports the pending legislation Improving Access to Medicare Coverage Act of 2011 (H.R. 1543 & S.818). The bill was introduced in the House of Representatives in April by Joe Courtney (D-Conn.) and Tom Latham (R-Iowa) and in the Senate by John Kerry (D-Mass.) and Olympia Snowe (R-Maine). This bipartisan bill would allow observation time in a hospital to count toward satisfying the 3-day inpatient requirement for SNF-services coverage by Medicare. In addition to AMDA and the American Health Care Association, the Center for Medicare Advocacy, AARP, LeadingAge, the AMA, and the National Committee to Preserve Social Security and Medicare, which also participated in the congressional briefing, support the legislation. Heather Boyd is a member of the government affairs staff at AMDA.