Medicaid Home and Community-Based Services in the Wake of the COVID-19 Pandemic.

The need to bolster Medicaid home and community-based services (HCBS) became more evident during the COVID-19 pandemic. This recognition stemmed from the challenges of keeping people safe in nursing homes and the acute workforce shortages in the HCBS sector. This article examines two major federal developments and state responses in HCBS options as a result of the pandemic.

Decrease in wearable-based nocturnal sleep efficiency precedes epileptic seizures.

Introduction: While it is known that poor sleep is a seizure precipitant, this association remains poorly quantified. This study investigated whether seizures are preceded by significant changes in sleep efficiency as measured by a wearable equipped with an electrocardiogram, respiratory bands, and an accelerometer.

Methods: Nocturnal recordings from 47 people with epilepsy hospitalized at our epilepsy monitoring unit were analyzed (304 nights).

A Comparative Analysis of State Implementation of the Community First Choice Program.

The Patient Protection and Affordable Care Act included Community First Choice (CFC), a new optional Medicaid home and community-based services (HCBS) state plan benefit which states could adopt. Through the CFC program, states can provide expanded home and community-based attendant services and supports to older adults and persons with disabilities. A benefit of CFC is that states receive a higher federal match rate than other HCBS programs.

Enhancing Federal Revenue under the American Rescue Plan Act: An Opportunity to Bolster State Medicaid Home and Community-Based Services Programs.

The American Rescue Plan Act (ARPA) includes a one-year 10 percentage point increase in the Federal Medical Assistance Percentage for Medicaid-funded home and community-based services (HCBS). The goal is to strengthen state efforts to help older adults and people with disabilities live safely in their homes and communities rather than in institutional settings during the COVID-19 pandemic. This essay provides a detailed description and analysis of this provision, including issues state governments need to consider when expending the additional federal revenue provided.

A comparative analysis of state adoption of the Community First Choice program.

Over the last several decades, policymakers have focused on rebalancing Medicaid-funded long-term services and supports toward home and community-based services (HCBS). The Patient Protection and Affordable Care Act (ACA) included several opportunities for states to further promote HCBS options. One optional opportunity for states to expand Medicaid HCBS was the 1915(k) Community First Choice (CFC) program.

A Comparative Case Study Analysis of Barriers and Facilitators to Implementing the Affordable Care Act's Balancing Incentive Program.

The Affordable Care Act included the opportunity for states to increase spending on Medicaid home and community-based services (HCBS) for older adults and persons with disabilities through the Balancing Incentive Program (BIP). This study utilized comparative case studies to identify the factors that facilitated or impeded states' implementation of BIP. Findings indicate factors that facilitated the implementation of BIP were communication with the federal government and its contractor, merging BIP with existing HCBS programs, and enhanced federal revenue.

Federal Incentives to Reform Long-Term Care Under the Affordable Care Act: State Adoption of the Balancing Incentive Program, 2011-2014.

Objectives: The Balancing Incentive Program (BIP) was an optional program for states within the Patient Protection and Affordable Care Act to promote Medicaid-funded home and community-based services (HCBS) for older adults and persons with disabilities. Twenty-one states opted to participate in BIP, including several states steadfastly opposed to the health insurance provisions of the Affordable Care Act. This study focused on identifying what factors were associated with states' participation in this program.

Ethics in electrophysiology: who speaks for this man?

In this case, a patient who is incapable of participating in health-care decisions requires a pacemaker generator replacement. Because the pacemaker may no longer be necessary, the issues of surrogacy and surrogate decision-making are considered. Where there are no involved family members, each state has procedures for finding an appropriate ombudsman for the patient who can assist in healthcare choices.

Ethics in electrophysiology: can you handle the truth?

A case is presented examining the need to disclose the truth in cases where there is a question of device and personnel performance. This case examines the responsibilities of physicians to their patients and the community at large to disclose factual accounts of events, even in the case of medical error and potential liability.

Aminodifluorosulfinium tetrafluoroborate salts as stable and crystalline deoxofluorinating reagents.

Aminodifluorosulfinium tetrafluoroborate salts were found to act as efficient deoxofluorinating reagents when promoted by an exogenous fluoride source and, in most cases, exhibited greater selectivity by providing less elimination byproduct as compared to DAST and Deoxo-Fluor. Aminodifluorosulfinium tetrafluoroborates are easy handled crystalline salts that show enhanced thermal stability over dialkylaminosulfur trifluorides, are storage-stable, and unlike DAST and Deoxo-Fluor do not react violently with water.

[The benefits of rehabilitation in people with low potential for recuperation].

Background: This article presents the story of a young man who sustained severe limitations following a traumatic brain injury. Considering his very slow recovery rate and a virtual absence of contact with the environment, hopes for rehabilitation were deemed very low. He was nevertheless admitted to a rehabilitation institute for a trial period in November of 2000.

A genetic history questionnaire-based system in primary prenatal care to screen for selected fetal disorders.

DNA (and other) diagnostic tests are now available for a number of serious, but uncommon, fetal disorders. We designed and evaluated a screening system for this purpose in primary care, coupled with targeted information for practitioners and patients. We developed a 15-question family history form for completion by office staff or patients, addressing conditions for which definitive diagnosis was available, linked to secondary questionnaires to follow up on "yes" answers.

Incidence and management of arrhythmias in women.

There are gender-specific differences in the nature and frequency of specific cardiac arrhythmias. Sex-specific variations in the electrophysiologic structure of the heart and/or hormonal effects on modulating ionic channel function may help to explain some of these differences, such as the increased prevalence of symptoms of congenital long QT syndrome in women, and the increase in episodes of supraventricular tachycardia in the perimenstrual period in susceptible patients. On the other hand, women suffer only 20% of sudden cardiac deaths.

[Regionalization of rehabilitation services. Survey of users of a Quebec center].

OBJECTIVE: To understand the situation of and difficulties encountered by users of a supraregional rehabilitation institute when they are transferred from the institute to facilities in their own regions, and to discover how they address these difficulties. DESIGN: Qualitative descriptive study. SETTING: Regions in Quebec served by a physical rehabilitation institute (Institut de réadaptation en déficience physique de Québec).

Severity and impact of pain after day-surgery.

Purpose: To assess the intensity, duration and impact of pain after day-surgery interventions. Predictors of pain severity were also evaluated along with the quality of analgesic practices and patient satisfaction.

Methods: Eighty-nine consecutive day-surgery patients completed self-administered questionnaires before leaving the hospital and at 24, 48 hr and seven days after discharge.

Repetitive sequence families in Alces alces americana.

High-resolution derivative melting was used to obtain detailed distributions of local (G + C) contents in a number of ruminant DNAs. Profiles over low (G + C) regions [20-36% (G + C)] are congruent for all ruminants. This region represents 45-50% of the nuclear DNA content and primarily contains intergenic and intron sequences.

Signal-averaged ECG prior to and serially after thrombolytic therapy for acute myocardial infarction.

Signal averaging has been performed to evaluate late potentials following infarction and the administration of thrombolytic therapy. Most studies have recorded signal-averaged electrocardiograms (SAECGs) at least 12 hours after the onset of the infarction. In this study, SAECGs were recorded before thrombolytic therapy and serially over 7-10 days following infarction in 21 patients.

Effects of exercise on signal-averaged electrocardiogram.

Signal averaging can be used to assess changes in myocardial activation under a variety of physiological conditions including stress. This study prospectively evaluated patients who underwent rest and exercise recording of signal-averaged electrocardiograms. The 163 patients were divided into three groups based on thallium results: normal (group I), reperfusion (group II), and fixed defect (group III).

The impact of managed care on genetic testing laboratories in the United States.

The traditional activities of clinical genetics programmes have focused on service, education and research. These activities have been funded on a fee-for-service basis often supplemented by service and research grants from private and government sources. Developing changes in health care financing threaten this approach to funding of genetics programmes in general and of genetics laboratories in particular.