Designing and implementing state-level fertility preservation health insurance benefit mandates

Objective To describe the design and implementation of state-level fertility preservation (FP) health insurance benefit mandates and regulation and to provide stakeholders with guidance on best practices, gaps, and implementation needs. Design Legal mapping and implementation framework-guided analysis Setting U.S. states with state-level fertility preservation health insurance benefit mandates Patients Individuals at risk of iatrogenic infertility Intervention State laws mandating health insurance benefit coverage for fertility preservation services. Main Outcome Measures Design features of FP mandated benefit legislation; implementation process Results Between June, 2017 and March, 2021, 11 states passed FP benefit mandate laws. On average, states took 223 days to implement their mandates from the start of the law enactment dates to their corresponding effective dates, and a majority issued regulatory guidance after the law was in effect. Significant variation was observed in which FP services were specified for inclusion or exclusion in the laws and/or regulator guidance. Federal policies impacted state level implementation, with the ACA and HIPAA guiding design of fertility preservation benefits. In addition, a majority of states referenced medical society clinical practice guidelines in the design of FP mandated benefits. Conclusions Our policy scan documented significant variation in the design and implementation of health insurance benefit mandates for FP services. Future considerations for policy development include specificity and flexibility of benefit design, reference to external clinical practice guidelines to drive benefit coverage, inclusion of Medicaid populations in required coverage, and consideration of interaction with relevant state and federal policies. In addition, key considerations for implementation include the sufficient length of time for the implementation period, regulator guidance issued prior to the law going into effect, and explicit allocation of resources for the implementation process.

Bereavement Support Services in a National Sample of Hospices: A Content Analysis

Although the Medicare Hospice Benefit mandates that hospices offer bereavement support services to families for at least 1 year following the death of a patient, it does not stipulate which services they should offer. As a result, little is known about what bereavement support services hospices provide, especially on a national scale. The current study recruited a national sample of hospice representatives who responded to an open-ended question that asked, “What types of bereavement support services does your hospice provide to families?” Seventy-six viable responses were recorded and content analyzed. Four overarching domains emerged: (a) timing of support, (b) providers of support, (c) targets of support, and (d) formats of support. Other notable findings included the underutilization of bereavement support services and the utility of informal support formats. These findings present implications for future study regarding which specific aspects of hospice bereavement support services are most beneficial to bereaved families.

Supporting employee lactation: Do U.S. workplace lactation benefit mandates align with evidence-based practice?

Feeding infants breastmilk (both directly and via pumping) is a pro-health behavior that has well-documented benefits for the mother and child. Although there are many factors that impact a mother’s decision to initiate and continue breastfeeding (e.g., family norms or health constraints), barriers to lactation at work in the postpartum period consistently predict breastfeeding discontinuation. In efforts to support women’s return to work postpartum and their lactation decisions, there are many mandates in the United States across the federal and state levels that provide protection and benefits for working women who are lactating. However, it is currently unclear how these mandates align with best practices of providing support to working mothers identified via organizational research. This Article reviews the federal and state mandates available to understand (1) what benefits/protections are offered, (2) how these benefits align with evidence-based recommendations for supporting lactating women, and (3) where lactating employees are being successfully supported or require additional support.

An Analysis of the Early and Periodic Screening, Diagnostic, and Treatment Benefit: Implications for the Healthcare of Children in Foster Care

The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit mandates full coverage of healthcare for children enrolled in Medicaid. The EPSDT benefit provides the access, framework, resources, and financing for healthcare for children with complex healthcare needs. When fully implemented, the EPSDT benefit leads to improved health outcomes. This paper examines the EPSDT benefit as an essential healthcare resource for vulnerable children, notably children in foster care. The majority of children in foster care receive Medicaid healthcare coverage and have complex healthcare needs. According to the most recent research, many children in foster care are not receiving this mandated benefit. Improved implementation of the EPSDT benefit is key to improving health outcomes. This policy analysis reviews the EPSDT benefit, evidence for its effectiveness, issues challenging full implementation for children in foster care, examples of successful implementation, and provides recommendations for improved implementation. Specific recommendations include coordination of healthcare and child welfare services (e.g. with health services coordinators), increased accountability for implementers, and adequate numbers of qualified, trauma-informed providers.

The political roots of health insurance benefit mandates

Purpose As of 2011, the average US state had 37 health insurance benefit mandates, laws requiring health insurance plans to cover a specific treatment, condition, provider, or person. This number is a massive increase from less than one mandate per state in 1965, and the topic takes on a new significance now, when the federal government is considering many new mandates as part of the “essential health benefits” required by the Affordable Care Act. The paper aims to discuss these issues. Design/methodology/approach The authors use fixed effects estimation on 1996-2010 data to determine why some states pass more mandates than others. Findings The authors find that the political strength of health care providers is the strongest determinant of mandates. Originality/value A large body of literature has attempted to evaluate the effect of mandates on health, health insurance, and the labor market. However, previous papers did not consider the political processes behind the passage of mandates. In fact, when they estimate the laws’ effect, almost all papers on the subject assume that mandates are passed at random. The paper opens the way to estimating the causal effect of mandates on health insurance and the labor market using an instrumental variables strategy that incorporates political information about why mandates get passed.