CODE || CFR ||
LEGISLATION || CASES ||
NIH:HSTAT || LINKS
Today's health consumers, or "patients" as
they were once called, are expected to know about and participate in
their care. That includes knowing about health laws and policies that
impact care. This page collects information on some current topics in
health care policy.
Electronic medical records? Patient
Identifiers? There hasn't been this much going on with wired
health care since United Health Care took down its internet pages
offering "virtual health care". See
Wired Health and
Medical Records Confidentiality.
We all need more rights, don't we? Now the
President has proposed an HMO Bill of Rights that seeks to ensure
accurate information, choice of providers, access to emergency
services, disclosure of incentives, patient respect and
confidentiality and grievance processes. Consumers are asked to act
responsibly, carry out treatment plans and report fraud. You can view
these proposed rights and related documents by clicking
One right conspicuously absent in all of
this is the right to sue your HMO, managed care organization or ERISA
Medical Records Confidentiality
- "A Federal health privacy law
should permit limited disclosures of health information
- without patient consent
for specifically identified national
Make no mistake about it -- the government
wants full access to your private medical information. In a report
presented to Congress on September 11, 1997, the Secretary of Health
and Human Services, Donna Shalala, details several reasons why new
federal legislation is necessary to protect patient privacy,
- It is necessary to provide rights for patients and define
responsibilities for record keepers.
- It is becoming difficult to determine the appropriate person
or place where our health information can be accessed or
- The legal control of health information is, in general, a
matter of State laws that vary greatly in scope and strength, and
the situation has been described as "a morass of erratic law, both
statutory and judicial, defining the confidentiality of health
- The Health Care Information System Is Increasingly Interstate.
Computerization and telecommunications render the concept of
"location" of information nearly meaningless.
The "national priority activities" for
which your medical records could be released without your consent
under the Secretary's plan include:
- Oversight of the Health Care System
- For Public Health, and in Emergencies Affecting Life or Safety
- For Health Research
- Pursuant to Other Laws or Court Orders
Talk about exceptions that swallow the
rule. But you decide for yourself -- here are the links to the
Recommendations of the Secretary of Health and Human Services,
pursuant to section 264 of the Health Insurance Portability and
Accountability Act of 1996.
INDIVIDUALLY-IDENTIFIABLE HEALTH INFORMATION
- Submitted to: The Committee on Labor and Human Resources and
the Committee on Finance of the
- Senate; The Committee on Commerce and the Committee on Ways
and Means of the House of
- Representatives, September 11, 1997.
Federal Legislation is Needed
for Establishing Federal Privacy Standards
-- Recommended Scope of A Federal Privacy Law
Federal Privacy Legislation Should Relate to Other Laws
Classes of Information
Awareness and Control
Authorized by the Patient
Classes of Persons and Entities
to Other Law
Is your health insurance coverage eroding?
Pursuant to a congressional request, GAO reviewed major trends in the
private health insurance market, during the 1980s and 1990s, focusing
on: (1) the decline in private health insurance coverage and factors
contributing to this decline; (2) trends in health insurance premiums
and reasons for these trends; and (3) employer's efforts to control
health benefits costs.
Health Insurance: Continued Erosion of Coverage Linked to Cost
Pressures. HEHS-97-122. July 24, 1997;
Health Insurance: Erosion In Employer-Based Health Benefits for Early
Retirees. HEHS-97-150. 19 pp. plus 5 appendices (6 pp.) July 11,
The Family and Medical Leave
29 USC sec. 2601, et. seq. has a major positive impact on
families, with virtually no impact on employers. The Act provides for
at least 12 weeks of unpaid leave from large companies for persons
employed for more than one year. As is the
case with many federal regulations, the Act sets forth minimum
standards but is probably rigidly applied. The spirit of the Act
recognizes the stress and additional responsibilities involved in
caring for new infants or family members with serious medical
of Labor Compliance Guide: Family & Medical Leave Act ~
CFR Part 825 - THE FAMILY AND MEDICAL LEAVE ACT OF 1993 ~
FMLA Fact Sheet ~
on Family Medical Leave
The August 21, 1996 signing of the
Portability and Accountability Act represented the first major
federal health reform legislation signed into law. What impact does
this law have on business, insurance companies and the public? For a
look at what the Clinton Administration says, click to the
HHS Fact Sheet,
Remarks by the President,
Statement by the President
and Press Briefing.
Viatical settlements -- contracts where
an investor acquires an interest in the life insurance policy of a
terminally ill person -- have been hailed both as blessings to the
terminally ill and the epitomy of greed in America. One thing is
v. Life Partners Inc the U.S. Court of Appeals for the District
of Columbia Circuit held that the SEC cannot regulate viatical
Code of Federal
CFR Part 825 - THE FAMILY AND MEDICAL LEAVE ACT OF 1993
What is the Family and Medical Leave Act?
What is the purpose of the Act?
When was the Act effective?
How did the Act affect leave in progress on, or taken before,
the effective date of the Act?
What employers are covered by the Act?
In determining whether an employer is covered by FMLA, what
does it mean to employ 50 or more employees for each working
day during each of 20 or more calendar workweeks in the current
or preceding calendar year?
How is "joint employment" treated under FMLA?
What is meant by "successor in interest"?
What is a "public agency"?
Are Federal agencies covered by these regulations?
Which employees are "eligible" to take leave under FMLA?
In determining if an employee is "eligible" under FMLA, how is
the determination made whether the employer employs 50
employees within 75 miles of the worksite where the employee
needing leave is employed?
Under what kinds of circumstances are employers required to
grant family or medical leave?
What do "spouse," "parent," and "son or daughter" mean for
purposes of an employee qualifying to take FMLA leave?
What is a "serious health condition" entitling the employee to
What does it mean that "the employee is unable to perform the
functions of the position of the employee"?
What does it mean that an employee is "needed to care for" a
For an employee seeking intermittent FMLA leave or leave on a
reduced leave schedule, what is meant by "the medical necessity
for" such leave?
What is a "health care provider"?
How much leave may an employee take?
If leave is taken for the birth of a child, or for placement of
a child for adoption or foster care, when must the leave be
How much leave may a husband and wife take if they are employed
by the same employer?
Does FMLA leave have to be taken all at once, or can it be
taken in parts?
May an employer transfer an employee to an "alternative
position" in order to accommodate intermittent leave or a
reduced leave schedule?
How does one determine the amount of leave used where an
employee takes leave intermittently or on a reduced leave
May an employer deduct hourly amounts from an employee's
salary, when providing unpaid leave under FMLA, without
affecting the employee's qualifications for exemption as an
executive, administrative, or professional employee, or when
utilizing the fluctuating workweek method for payment of
overtime compensation, under the Fair Labor Standards Act?
Is FMLA leave paid or unpaid?
Under what circumstances may an employer designate leave, paid
or unpaid, as FMLA leave and, as a result, count it against the
employee's total FMLA leave entitlement?
Is an employee entitled to benefits while using FMLA leave?
How may employees on FMLA leave pay their share of health
What special health benefits maintenance rules apply to
multi-employer health plans?
What are the consequences of an employee's failure to make
timely health plan premium payments?
May an employer recover costs it incurred for maintaining
"group health plan" or non-health benefits coverage during FMLA
What are an employee's rights on returning to work from FMLA
What is an equivalent position?
Are there any limitations on an employer's obligation to
reinstate an employee?
What is a "key employee"?
What does "substantial and grievous economic injury" mean?
What are the rights of a key employee?
How are employees protected who request leave or otherwise
assert FMLA rights?
What posting requirements does the Act place on employers?
What other notices to employees are required of employers under
What notice does an employee have to give an employer when the
need for FMLA leave is foreseeable?
What are the requirements for an employee to furnish notice to
an employer where the need for FMLA leave is not
What recourse do employers have if employees fail to provide
the required notice?
When must an employee provide medical certification to support
How much information may be required in medical certifications
of a serious health condition?
What may an employer do if it questions the adequacy of a
Under what circumstances may an employer request subsequent
recertifications of medical conditions?
What notice may an employer require regarding an employee's
intent to return to work?
Under what circumstances may an employer require that an
employee submit a medical certification that the employee is
able (or unable) to return to work (e.g., a
What happens if an employee fails to satisfy the medical
Under what circumstances may a covered employer refuse to
provide FMLA leave or reinstatement to eligible employees?
What may employees do who believe that their rights under FMLA
have been violated?
Where may an employee file a complaint of FMLA violations with
the Federal government?
How is an employer notified of a violation of the posting
How may an employer appeal the assessment of a penalty for
willful violation of the posting requirement?
What are the consequences of an employer not paying the penalty
assessment after a final order is issued?
What Records must an employer keep to comply with the FMLA?
To whom do the special rules apply?
What limitations apply to the taking of intermittent leave or
leave on a reduced leave schedule?
What limitations apply to the taking of leave near the end of
an academic term?
Is all leave taken during "periods of a particular duration"
counted against the FMLA leave entitlement?
What special rules apply to restoration to "an equivalent
What if an employer provides more generous benefits than
required by FMLA?
Do State laws providing family and medical leave still
How does FMLA affect Federal and State anti-discrimination
- 45 CFR PART 60 - NATIONAL PRACTITIONER DATA BANK FOR ADVERSE
INFORMATION ON PHYSICIANS AND OTHER HEALTH CARE PRACTITIONERS
SUBPART A - GENERAL PROVISIONS
v. MCNEIL-P.P.C., INC. (4th Cir., October 10, 1995) (upholding
$8 million award for liver damage caused by mixing alcohol with
v. Director, Mo. Dept. of Health, 497 U.S. 261 (1990) (U.S.
Constitution does not forbid Missouri to require that evidence of
an incompetent's wishes as to the withdrawal of life-sustaining
treatment be proved by clear and convincing evidence).
v. McKinney (U.S., June 18, 1993) (prisoner's involuntary
exposure to environmental tobacco smoke (ETS) from other inmates'
cigarettes posed an unreasonable risk to his health)
York State Conference of Blue Cross & Blue Shield Plans v.
Travelers Ins. Co., 115 S. Ct.1671, 131 L. Ed. 2d 695 (1995).
(surcharges that indirectly impact ERISA plans not preempted)
v. Whitecotton (U.S., April 18, 1995) (claimant who
experienced symptoms of injury after receiving vaccination does
not make out prima facie case for compensation under Vaccine
Injury Act when evidence fails to indicate no symptoms of injury
prior to vaccination)
CORPORATION v. HOWE (U.S. March 19, 1996) (Varity and
Massey-Ferguson, acting as ERISA fiduciaries, harmed plan
beneficiaries through deliberate deception violating ERISA's
404(a)'s fiduciary obligation)
Term Care: Baby Boom Generation Presents Financing Challenges.
T-HEHS-98-107. 14 pp. March 9, 1998.
Health Insurance: Erosion in Retiree Health Benefits Offered by
Large Employers. T-HEHS-98-110. 12 pp. March 10, 1998.
Insurance: Coverage Leads to Increased Health Care Access for
Children. HEHS-98-14. 27 pp. plus 2 enclosures (13 pp.)
November 24, 1997.
Fewer and Lower Cost Beneficiaries With Chronic Conditions Enroll
in HMOs. HEHS-97-160. 18 pp. plus 2 appendices (6 pp.) August
Policy: Health Insurance Tax Credit Participation Rate Was Low
(Letter Report, 05/02/94, GAO/GGD-94-99). This report provides
information on the health insurance tax credit, which was
established to encourage low-income workers to buy private health
insurance for their families.
WIC's Efforts to Promote Breastfeeding Have Increased (Letter
Report, 12/16/93, GAO/HRD-94-13). The Department of Health and
Human Services has set a goal, by the year 2000, of increasing the
percentage of women who breastfeed their infants to at least 75
percent at hospital discharge and to at least 50 percent at five
to six months postpartum.
and Medicaid: Many Eligible People Not Enrolled in Qualified
Medicare Beneficiary Program (Letter Report, 01/20/94,
GAO/HEHS-94-52). The Qualified Medicare Beneficiary Program pays
many out-of-pocket expenses for Medicare recipients whose incomes
are not quite low enough to qualify them for regular Medicare
Beneficiary Liability for Certain Paramedic Services May Be
Substantial (Briefing Report, 04/15/94, GAO/HEHS-94-122BR).
Volunteer ambulance companies often transport Medicare patients to
Insurance for the Elderly: Owning Duplicate Policies Is Costly and
Unnecessary (Letter Report, 08/03/94, GAO/HEHS-94-185). Owning
multiple health insurance policies to supplement Medicare is both
costly and unnecessary. GAO estimated that about 3 million elderly
Medicare beneficiaries paid about $1.8 billion in 1991 for
policies that probably involved duplicate coverage.
Care Reform: "Report Cards" Are Useful but Significant Issues Need
to Be Addressed (Chapter Report, 09/29/94, GAO/HEHS-94-219).
As part of the debate over health care reform, Congress is
considering requiring health plans to provide prospective
purchasers with information on the quality of care they furnish.
Self-Determination Act: Providers Offer Information on Advance
Directives but Effectiveness Uncertain (Letter Report,
09/01/95, GAO/HEHS-95-135). Pursuant to a congressional request,
GAO provided information on the implementation of the Patient
Self-Determination Act (PSDA), and the effectiveness of advance
directives in ensuring a patient's desired care.
Drugs and the Elderly: Many Still Receive Potentially Harmful
Drugs Despite Recent Improvements (Letter Report, 07/24/95,
GAO/HEHS-95-152). Pursuant to a congressional request, GAO
examined the elderly's inappropriate use of prescription drugs.
Insurance for Children: Many Remain Uninsured Despite Medicaid
Expansion (Letter Report, 07/19/95, GAO/HEHS-95-175). Pursuant
to a congressional request, GAO reviewed the status of health
insurance for children.
Care: Employers and Individual Consumers Want Additional
Information on Quality (Letter Report, 09/29/95,
GAO/HEHS-95-201). Pursuant to a congressional request, GAO
provided information on health care quality issues, focusing on:
(1) how consumers use health care performance reports that contain
comparative data on the quality of health care providers; and (2)
what information consumers consider most important.
Insurance Portability: Reform Could Ensure Continued Coverage for
Up to 25 Million Americans (Letter Report, 09/19/95,
GAO/HEHS-95-257). Pursuant to a congressional request, GAO
provided information on: (1) the protections offered by current
state and federal health insurance portability reforms; (2) the
number of people who could be affected by broader national
portability standards; and (3) other issues related to the design
of national portability standards.
and Abuse: Providers Target Medicare Patients in Nursing
Facilities (Letter Report, 01/24/96, GAO/HEHS-96-18). Pursuant
to a congressional request, GAO reviewed allegations of fraud and
abuse related to services and supplies provided to nursing
Insurance: Alternatives for Medicare Beneficiaries to Avoid
Medical Underwriting (Letter Report, 09/10/96,
GAO/HEHS-96-180). Pursuant to a legislative requirement, GAO
reviewed Medigap policies, focusing on: (1) the extent to which
Medicare beneficiaries are subject to medical underwriting when
they change Medigap policies; and (2) options for modifying
federal Medigap requirements to ensure that medical underwriting
is not a problem in such cases.
Care: Appropriate Follow-Up Services Critical With Short Hospital
Stays (Letter Report, 09/11/96, GAO/HEHS-96-207). Pursuant to
a congressional request, GAO reviewed issues surrounding shortened
postpartum hospital stays.
Health Insurance: Costs Increase and Family Coverage Decreases
(Letter Report, 02/24/97, GAO/HEHS-97-35). Pursuant to a
congressional request, GAO provided information on the decline in
employment-based health insurance.
Care Services: How Continuing Care Retirement Communities Manage
Services for the Elderly (Letter Report, 01/23/97,
GAO/HEHS-97-36). Pursuant to a congressional request, GAO reviewed
the processes of managed care in continuing care retirement
communities (CCRC), focusing on: (1) CCRC practices for promoting
wellness; (2) practices for managing care for elderly people with
chronic conditions; and (3) evidence regarding the possible effect
of these practices on health status and costs.
Care: Consumer Protection and Quality-of-Care Issues in Assisted
Living (Letter Report, 05/15/97, GAO/HEHS-97-93). Pursuant to
congressional request, GAO reviewed assisted living facilities
(ALF), focusing on: (1) responsibilities of federal and state
governments and ALFs in ensuring quality and protecting consumers
living in ALFs; and (2) issues that may require further research.
Survival: An International Comparison of Outcomes (Chapter
Report, 03/07/94, GAO/PEMD-94-5). In comparing U.S. and Canadian
survival rates for lung cancer, colon cancer, Hodgkin's disease,
and breast cancer, GAO found that breast cancer patients lived
longer after diagnosis in the United States than in Canada.
With Disabilities Act: Effects of the Law on Access to Goods and
Services (Letter Report, 06/21/94, GAO/PEMD-94-14). This
report looks at the extent to which the Americans With
Disabilities Act has improved the access for persons with
disabilities to goods and services provided by businesses and
state and local governments.
HHS Could Do More to Increase Vaccination Among Older Adults
(Chapter Report, 06/08/95, GAO/PEMD-95-14). Pneumonia and
influenza are the leading causes of vaccine- preventable death.
The elderly suffer the most from these diseases and the costs to
the federal government are substantial.
Treatment: A Review of the Clinical Trials Evidence (Letter
Report, 05/14/96, GAO/PEMD-96-7). Pursuant to a congressional
request, GAO reviewed the evidence from clinical trials that the
National Heart, Lung, and Blood Institute (NHLBI) used to develop
its National Cholesterol Education Program guidelines.
of Health Care Task Force Related Activities (Testimony,
03/14/95, GAO/T-GGD-95-114). In January 1993, President Clinton
established a task force on health care reform.
Chief Executives' Compensation, 1989-1991 (Testimony,
12/07/93, GAO/T-HRD-94-70). In recent years, the media have
scrutinized the high salaries--some approaching $1 million
annually--paid to health care executives, in some cases linking
them to the rising cost of health care.
of Marriage Act: Federal Benefits, Rights, and Privileges
Contingent on Marital Status GAO/OGC-97-16, Jan. 31, 1997.
Nursing Facilities: Approval Process for Certain Services May
Result in Higher Medicare Costs. HEHS-97-18. 51 pp. plus 7
appendices (82 pp.) December 20, 1996.
National Immunization Survey: Methodological Problems Limit
Survey's Utility. GAO/PEMD-96-16. September 19, 1996.
Hospital Association's Patient's Bill of Rights (1973) The AHA
Patient's Bill of Rights, printed in full below, has been
influential in the development of similar documents in other parts
of the world.
Information - Health This service is provided by the Consumer
Information Center of the U.S. General Services Administration.
Hotlines Health Hotlines is a compilation of organizations
with toll-free telephone numbers.
Breast Cancer War For the first time in four decades, American
women can celebrate winning a battle in the war against breast
Health Resolutions The great baseball manager, Casey Stengel
once quipped upon turning eighty, "If I had known I was going to
live this long, I would have taken better care of myself."
Violence & Health The holiday season is supposed to be a
time of peace, a time to pause and count our blessings with family
Protecting Your Health
When You Need an Operation
News from the College
Information on Patient Choice
- HHS: Health
Advisory On Fen/Phen for Obesity
- HHS: Medicare
Fraud Hotline Improved and Expanded
- HHS: Operation
Restore Trust Accomplishments
- HHS: Shalala
Launches Healthfinder Web Site; Improves Consumer Access to
- HHS: Vice
President Gore Launches Free Access to MEDLINE
- HHS: FDA
Proposes New, Easy to Understand Labeling for OTC Drugs
- HHS: Health
Advisory On Fen/Phen for Obesity
- HCFA: HIPAA
Questions - Consumers
- HCFA: What to
look for in a Nursing Home
- HHS Sites
- HCFA Health
- HCFA: 10
- HCFA: Managed
Care in Medicare and Medicaid
- HCFA: Managing
Medicare Fact Sheet
Medicare's Second Opinion Coverage
Prohibition on time limits for breast surgery
- HCFA: Rapid
Response to Treatment Denial Appeals Promised
NATIONAL INSTITUTES OF HEALTH:
's Home Page ~
(Americans with Disabilities Act) ~
Administration for Children
and Families ~
Health Information: NY State Dept. of Health ~
Family Health Council of
Central PA ~
FHP Health Care Information
Ask Alice! ~
Benefits Under COBRA ~
Press Releases ~
Ethics: Codes and Policies ~
Directory of Internet Health ~
Office of Disease
Prevention and Health Promotion (ODPHP) Home Page ~
Reimbursement Assistance Programs ~
Page ~ State Pharmacy Assistance Programs ~
Taxpayers Against Fraud ~
Doctor-Patient Relationship Seminars ~
The Home Care Page ~
Welcome to Access
HIPPOHOME // HIPPONEWS //
SEARCHING? // TRAGICALLY
Health Hippo © 1996-2000: firstname.lastname@example.org