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Simplifying the US healthcare system is far from a new challenge, but recent announcements by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) have solidified the importance of tech standardization and interoperability as some of the biggest combatants of bureaucratic red tape. Prior authorizations, or PAs, have long symbolized the epitome of these patient care bottlenecks, and as new demands come to the forefront, these long-standing procedures are facing higher scrutiny.

The Basics

Prior authorization, or PA, is the process that providers-such as doctors, nurses and pharmacists-undergo in which they make a case to health plans that the prescribed medication or procedure is medically necessary and should be covered. Not all prescriptions or services require PAs, but because the exchange between payers and providers is often conducted via phone or fax, determinations can take anywhere from a few minutes to several weeks and may require multiple submissions or appeals. …

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COVID-19 has upended holiday plans for most, but for those living in nursing or assisted living facilities, the pandemic’s effects on the season are brought into an even sharper focus. As some of the most at-risk patients for the virus, senior citizens’ additional restrictions on visiting family members may in fact take a higher mental health toll than the majority of the population.

But most residents, families and staff are not letting stay-at-home mandates keep them from celebrating the holidays, albeit unconventionally. With stricter orders starting up again in many parts of the country, in-person visits have diminished or ceased altogether, as each new positive case in a facility typically requires a shift to solely digital interactions with non-residents. …

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The term “interoperability” has become so commonplace in healthcare and technology circles that everyone seems to recognize its importance, but defining what it is and where the problems lie can be confusing. If you’ve ever heard the term in seemingly unrelated scenarios and scratched your head, you’re not alone.

What is healthcare interoperability and why is it important?

All healthcare facilities have a system of storing information, especially as electronic records have become the baseline standard for housing patient data. Interoperability in healthcare refers to how these different informational systems and applications integrate with one another and exchange data for the purposes of providing useful information to providers, patients, researchers and other stakeholders. A lack of decent interoperability often results in fragmented patient data, leading to medical errors, denied insurance claims, delays in treatment and more. …

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Whether you’re covered by a private employer-based plan or the ACA Marketplace, open enrollment periods typically fall between November and December each year, and they give you an opportunity to change health plans for any reason. While most of the ACA Marketplace enrollment rules and deadlines remain the same as previous years, COVID-19 has stirred up much confusion for anything health coverage-related. And because many Americans have experienced either economic or medical hardship due to COVID-19, it’s important to understand updates to coverage requirements and Special Enrollment periods in light of the pandemic.

Open Enrollment Period Dates & Information

In order to change your health plan outside of an open enrollment period, a qualifying life event must have occurred, such as termination of coverage due to job loss. While different states and private, employer-based insurance plans have their own set of rules for open enrollment, any plan offered as part of the ACA Health Insurance Marketplace — or Exchange — must at minimum adhere to certain federal standards for open enrollment and special enrollment periods. …

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The future of AI in healthcare often conjures up images of robot doctors and virtual clinics. Certainly, recent breakthroughs in the field give reason to be optimistic, and market reports show a jump in healthcare AI investment from $2.6 billion to $4 billion between 2018 to 2019. But day-to-day usage of AI that dominates the field consists not of computerized medical staff but rather tools that cut down bureaucratic and administrative burden and aid in clinical decisions. According to a recent Center for Connected Medicine report, most survey respondents used AI tools for clinical decision support and dictation assistance or transcription. …

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Despite the devastating public health and economic impacts of COVID-19, many are hopeful that the Great Pause — as some have coined the quarantine — may foster an ease in rancorous political divisions seen in the U.S. While there is some albeit scant evidence that is happening, economic and public health uncertainties spurred by the pandemic are more often unmasking deep-seated divisions.

One such political movement in Illinois has only further manifested itself amidst state and city issued stay-at-home orders. Residents in central and southern counties of Illinois have started expressing the desire to secede in light of these orders. …

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President Donald Trump’s decision in October not to freeze hundreds of millions of dollars in foreign aid to Central America elicited a general sigh of relief, particularly among U.S. Congress and administration officials. But the apparent relief from that decision belies humanitarian and political corruption issues that many social activist groups say are enabled by that same funding.

U.S. foreign assistance funding for security assurance — used to arm and train military and police forces — has constituted an increasingly larger percentage of foreign aid in the past decade. According to data from the Security Assistance Monitor, in 2010, about $457 million was spent on economic aid in the region, with an additional $108 million spent on security. …

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An annual report on virtual education released last week reinforces the need for oversight and accountability in a growing niche market. But recent scandals among online institutions have done little to spur action from state or federal officials.

The Nation Education Policy Center publishes an annual report on virtual education in an effort to provide oversight on cyber school performance. The report, which has been published every year since 2013, evaluates the status of K-12 online learning and offers recommendations on how statewide policymakers can enforce higher standards.

While there were some improvements from the year prior, data for the 2017–18 school year reveals that about half of full-time virtual schools have acceptable student performance ratings. The report also notes about half virtual school students graduate, compared to the national average of 84%. …

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Labor unions in California received a double blow of decreased membership rates and an unfavorable U.S. Supreme Court ruling in 2018. But a Democratic governor with a proclivity for supporting organized labor and continuing lobbying efforts have proved those blows are not a death knell for unions in the Golden State.

In a state with a strong historical record of backing organized labor rights, union membership among California’s public employees saw a 4.7% drop from 2018 to 2017. That drop in membership occurred in the midst of Janus vs. …

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A little over a year ago, President Trump signed the Bipartisan Budget Act, which not only kept the government afloat in the midst of a shutdown, but also signified the passage of an important piece of bipartisan legislation. The new child welfare law, or the Family First Prevention Services Act, now allows states to use their federal Title IV-E funding for family services that could prevent children from entering foster care. Previously, this funding could only be used for children already in care, such as maintenance payments to foster families or program management costs. …

Alyse DiNapoli

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