The impact of Medicare, Medicaid and Schip Extension Act of 2007 (MMSEA) on the long term acute care hospitals

The Long Term Acute Care Hospitals (LTACH), which serve medically complex patients, have grown tremendously in recent years, by expanding the number of Medicare patient admissions and thus increasing Medicare expenditures (Stark 2004). In an attempt to mitigate the rapid growth of the LTACHs and reduce related Medicare expenditures, Congress enacted Section 114 of P.L. 110-173 (§114) of the Medicare, Medicaid and SCHIP Extension Act (MMSEA) in December 29, 2007 to regulate the LTCAHs industry. MMSEA increased the medical necessity reviews for Medicare admissions, imposed a moratorium on new LTCAHs, and allowed the Centers for Medicare and Medicaid Services (CMS) to recoup Medicare overpayments for unnecessary admissions. ^ This study examines whether MMSEA impacted LTACH admissions, operating margins and efficiency. These objectives were analyzed by comparing LTACH data for 2008 (post MMSEA) and data for 2006-2007 (pre-MMSEA). Secondary data were utilized from the American Hospital Association (AHA) database and the American Hospital Directory (AHD).^ This is a longitudinal retrospective study with a total sample of 55 LTACHs, selected from 396 LTACHs facilities that were fully operational during the study period of 2006-2008. The results of the research found no statistically significant change in total Medicare admissions; instead there was a small but not statistically significant reduction of 5% in Medicare admissions for 2008 in comparison to those for 2006. A statistically significant decrease in mean operating margins was confirmed between the years 2006 and 2008. The LTACHs' Technical Efficiency (TE), as computed by Data Envelopment Analysis (DEA), showed significant decrease in efficiency over the same period. Thirteen of the 55 LTACHs in the sample (24%) in 2006 were calculated as “efficient” utilizing the DEA analysis. This dropped to 13% (7/55) in 2008. Longitudinally, the decrease in efficiency using the DEA extension technique (Malmquist Index or MI) indicated a deterioration of 10% in efficiency over the same period. Interestingly, however, when the sample was stratified into high efficient versus low efficient subgroups (approximately 25% in each group), a comparison of the MIs suggested a significant improvement in Efficiency Change (EC) for the least efficient (MI 0.92022) and reduction in efficiency for the most efficient LTACHs (MI = 1.38761) over same period. While a reduction in efficiency for the most efficient is unexpected, it is not particularly surprising, since efficiency measure can vary over time. An improvement in efficiency, however, for the least efficient should be expected as those LTACHs begin to manage expenses (and controllable resources) more carefully to offset the payment/reimbursement pressures on their margins from MMSEA.^

Impact of seasonality-adjusted flexible microcredit on repayment and food consumption : experimental evidence from rural Bangladesh

The mismatch between credit repayments and income seasonality poses a challenge for microfinance institutions (MFIs) working in developing countries. For instance, in northern Bangladesh, income and consumption downfalls during the lean season after the transplanting of major paddy crops are a serious threat to a household's economy. Poor landless agricultural wage laborers suffer the most owing to this seasonality as they face difficulties in smoothing their consumption. However, in designing microcredit products, MFIs do not usually provide flexibility or seasonal adjustment during the lean season. This is mainly because MFIs are afraid that such flexibility might break the repayment discipline of borrowers, resulting in higher default rates. We thus conducted a randomized controlled trial in 2011-12 in northern Bangladesh to empirically test whether seasonality-adjusted flexible microcredit leads to an increase in repayment problems for MFIs as well as whether it can increase and stabilize consumption of borrower households. Our results suggest no statistically discernible difference among the treatment arms in case of default, overdue amount, or repayment frequency. On the other hand, we find no positive impact of repayment flexibility on immediate food consumption during the period of seasonality, except for in-kind full moratorium treatment group. After a year of initial intervention, however, we see positive changes in food intake during the lean season. Thus, our preliminary results are in favor of seasonality-adjusted flexible microcredit.

Shale gas in Bulgaria, the Czech Republic and Romania. Political context - legal status - outlook. OSW Report, September 2012

Despite their initial interest in shale gas exploration, over the past year Bulgaria, the Czech Republic and Romania have become increasingly sceptical about the development of unconventional gas resources. In January of this year Bulgaria introduced an indefinite ban on the exploration and production of shale gas and Romania followed suit in May by introducing a six-month moratorium on exploration work, which it plans to extend by another two years following the country’s parliamentary elections scheduled for December. Similar measures are being planned by the government in Prague. The aim of this report is to explore the reasons why countries which claim to want to improve their energy security have been showing increasing scepticism towards shale gas.

Ley de pagos de 24 de diciembre de 1917, que levanta en parte el moratorio para el pago de prestaciones en dinero : contiene, además el decreto de 14 de diciembre de 1916 que estableció el moratorio general y la circular que lo aclaró.

Mode of access: Internet.

S. 219--Regulatory Transition Act of 1995 : hearing before the Committee on Governmental Affairs, United States Senate, One Hundred Fourth Congress, first session, on S. 219 ... February 22, 1995.

"To ensure economy and efficiency of federal government opertions by establishing a moratorium on regulatory rulemaking actions, and for other purposes"

Copies of Proclamations, Orders in Council and documents relating to the European war.

Appendices: A. The sixth convention of the Second Peace Conference held at The Hague in 1907.--B. The Naval prize act, 1864. The Prize Court act, 1894. The Prize Court (procedure) act, 1914.--C. Sections from the Customs act.--D. The Declaration of London. General report on the Declaration of London, presented to the Naval Conference.--E. The War measures act, 1914. The Finance act, 1914. The Dominion notes act, 1914.--F. Patents of invention in enemy countries.--G. French moratorium. French contraband.

Copies of proclamations, orders in Council and documents relating to the European war.

Appendices: A. The sixth convention of the Second peace conference held at The Hague in 1907.--B. The Naval prize act, 1864. The Prize court act, 1894. The Prize court (procedure) act, 1914.--C. Sections from the Customs act.--D. The Declaration of London, General report on the Declaration of London, presented to the naval conference.--E. The War measures act, 1914. The Finance act, 1914. The Dominion notes act, 1914.--F. Patents of invention in enemy countries.--G. French moratorium. French contraband.

An interview-based cognitive analysis of stakeholder perceptions of whale watching in Puget Sound, Washington

Thesis (Master's)--University of Washington, 2016-06

Informing Marine Spatial Planning (MSP) with numerical modelling: A case-study on shellfish aquaculture in Malpeque Bay (Eastern Canada)

A moratorium on further bivalve leasing was established in 1999–2000 in Prince Edward Island (Canada). Recently, a marine spatial planning process was initiated explore potential mussel culture expansion in Malpeque Bay. This study focuses on the effects of a projected expansion scenario on productivity of existing leases and available suspended food resources. The aim is to provide a robust scientific assessment using available datasets and three modelling approaches ranging in complexity: (1) a connectivity analysis among culture areas; (2) a scenario analysis of organic seston dynamics based on a simplified biogeochemical model; and (3) a scenario analysis of phytoplankton dynamics based on an ecosystem model. These complementary approaches suggest (1) new leases can affect existing culture both through direct connectivity and through bay-scale effects driven by the overall increase in mussel biomass, and (2) a net reduction of phytoplankton within the bounds of its natural variation in the area.