Scope of Practice – Physician Assistants (PAs)
Scope of practice describes the procedures, actions and processes that a healthcare practitioner in a given field is permitted to undertake according to the law. Scope of practice policies and regulations, which are applicable to professionals across the field of medicine, vary substantially from state to state and, in some instances, continue to spark passionate debates about the proper extent to which medical professionals should be permitted to exercise certain responsibilities.
Physician Assistants, or PAs, are nationally certified and state-licensed medical professionals who work with physicians and other providers to treat patients. Among other things, PAs can take patients’ medical history, conduct physical exams, diagnose and treat illnesses, order and interpret tests, develop treatment plans, counsel on preventive care, assist in surgery, write prescriptions, and make rounds in hospitals and nursing homes. However, specifically designated duties depend on a number of factors, including work setting, level of experience, specialty and, lastly, state laws.
A list of scope of practice regulations currently in place among SLC states, as well as a set of maps outlining various scope of practice policies throughout the United States, follows.*
|SLC States||Full prescriptive authority||Scope of practice determined on site||Adaptable supervision requirements||Co-sign requirements determined at practice||Maximum number of PAs a physician can supervise at one time|
How many Zika infections have been confirmed in SLC Member States?
Although a large-scale Zika outbreak is not likely in the United States, leading health officials have warned that localized infections are probable in the months ahead, particularly across the South, as warmer temperatures create hospitable climate conditions for disease-carrying mosquitoes. As of May 2016, all confirmed infections in the United States have been associated with travelers who visited countries with known Zika outbreaks.
(current as of April 27, 2016)
(click on headers to sort by column)
|State||Zika Infections||Percent of U.S. Infections|
Source: Centers for Disease Control and Prevention
Marijuana Use: Uncertainty on All Sides Continues
State legislatures continue to grapple with the myriad issues surrounding the legalization of medical marijuana as well as recreational marijuana. The following reflects a sampling of the research, articles and studies seeking to address questions related to whether marijuana and other substances are ‘gateway’ drugs. This information was compiled in response to an inquiry from a legislator in an SLC state.
A report from the National Institutes of Health’s National Institute on Drug Abuse. There are several references embedded in the report that provide scientific details on whether marijuana is a gateway drug.
A study, Probability and Predictors of the Cannabis Gateway Effect: A National Study, published in February 2015 in the International Journal of Drug Policy, maintains that the predictors of progression from cannabis to other illicit drugs remain largely unknown.
Another 2015 study in the International Journal of Drug Policy entitled, The Effect of Medical Cannabis Laws on Juvenile Cannabis Use, concludes that there is little empirical evidence to support the view that medical cannabis laws affect juveniles' use of illicit non-cannabis drugs.
An October 2015 article in the Chicago Tribune indicates that a University of Florida study found that alcohol - not marijuana - is the gateway drug that leads adolescents down the path toward more serious substances.
In a posting entitled Why Nicotine is a Gateway Drug, the NIH maintains that “Nicotine, the researchers found, makes the brain more susceptible to cocaine addiction. The finding suggests that lowering smoking rates in young people might help reduce cocaine abuse.”
State Authority to Admit Refugees: Background and Recent Developments
State Authority to Admit Refugees: Background and Recent Developments
The issue of state authority in refugee resettlement was largely unaddressed prior to November 2015, when security concerns, stemming from Syrian-linked terrorist attacks in Paris, led 31 governors to restrict refugee resettlement in their states. Historically, refugee admissions have been a federal issue, as it relates to immigration and foreign affairs. The Immigration and Nationality Act, amended by the Refugee Act of 1980, establishes the process by which the federal government sets refugee priorities.
|Total Refugee Arrivals||Syrian Refugee Arrivals|
How did SLC member states fare on the American Lung Society's annual State of the Air report?
The American Lung Society recently released its annual State of the Air report. Overall, SLC states fared well in several of the “cleanest cities” categories. Cities in SLC member states comprise half of the top 10 cleanest cities for Ozone Air Pollution and also six of the top 10 cleanest cities for Short-Term Particulate Pollution.
More information on the cleanest cities can be found here.
More information on the most polluted cities can be found here.
Cleanest U.S. Cities for Ozone Air Pollution:
Cleanest U.S. Cities for Short-term Particulate Pollution:
What are the vaccination rates for one- to three-year-olds in SLC member states?
On August 27, 2015, the U.S. Centers for Disease Control & Prevention released data from the 2014 National Immunization Survey (NIS) looking at immunization coverage among children 19-35 months of age with state-level estimates, along with vaccination coverage among children at school entry by state during the 2014-2015 school year. Vaccines remain one of the most effective tools available for the prevention of childhood diseases. Since 1994, NIS has monitored vaccination coverage among U.S. children aged 19‐35 months for vaccines recommended by the Advisory Committee on Immunization Practices. To gauge progress toward achieving full vaccination with recommended childhood vaccines, observed coverage levels are compared to targets set by Healthy People 2020.
|State||Percentage of children aged 19‐35 months with a combined vaccine series *|
Retiree Health Care and GASB Statements 74 and 75
The impact of the Governmental Accounting Standards Board (GASB) Statements 74 and 75, designed to improve the accounting and financial reporting by state and local governments for Other Post-Employee Benefits (OPEB), primarily retiree health insurance, varies across the United States.
Along with challenges related to funding their pension plans, states also face critical challenges related to adequately funding their retiree health care costs. GASB Statements 74 and 75, designed to go into effect in the fiscal year beginning after June 15, 2016 (Statement 74) and in the fiscal year beginning after June 15, 2017 (Statement 75), pose additional complications for policymakers as they seek to devise mechanisms to adequately fund these expenditures.
In the last decade or so, the number of state governments offering retiree health care benefits has been declining. In recent years, states have deployed a number of different strategies to transfer a greater portion of the cost of providing retiree health care to employees and retirees compared to earlier periods.
In probing the states with the highest unfunded actuarial liability (or UAAL) in terms of their OPEB, of which retiree health care costs are the most significant component, the following top 10 loom large:
The Status of Medicaid Expansion in SLC States
ALABAMA Governor Robert Bentley (R) indicated in December 2014 that he was open to the possibility of Medicaid expansion in the form of a state-designed program that uses private sector insurance and imposes work and job training requirements on the recipients. Governor Bentley has signaled that he may ask the federal government for a block grant to accomplish this expansion. The Alabama Legislature currently is considering a Joint Resolution that reaffirms their opposition to Medicaid expansion and urges Governor Bentley from taking any steps to expand the state's program. The resolution passed the Alabama Senate on April 21 and currently awaits action in the House.
ARKANSAS Arkansas has reauthorized funding for its private option alternative to Medicaid expansion through FY 2016. Under additional legislation passed during the 2015 session, the private option expansion will terminate on December 31, 2016, and a newly created legislative task force will make recommendations on alternative coverage models and reforms for the entire Medicaid program by December 31, 2015. Given that the General Assembly is not scheduled to meet again for a regular legislative session until 2017 (2016 is a fiscal session), Governor Hutchinson expects that a special session will be necessary to take action on the future of the state's Medicaid program.
According to the Arkansas Department of Human Services, 188,023 individuals have enrolled through the private option program, with an additional 25,117 medically frail individuals enrolled in traditional Medicaid, as of November 30, 2014.
Rural Hospital Funding in Non-Expansion States
Improving Funding for Rural Hospitals Between January 2010 and December 2014, 47 rural and critical access hospitals have closed around the country, 31 of which are in SLC states. As of January 2015, 24 of those hospitals remain closed, 10 have been converted to outpatient and primary care rural health clinics, nine have been converted to urgent or emergency care centers, and four have been converted to rehabilitation or nursing facilities. 1 Under the federal Affordable Care Act (ACA), Medicaid Disproportionate Share Hospital (DSH) payments were set to begin phasing out in FY2014. Under the plan, the phasing out of DSH payments, which are intended to provide additional funding to hospitals that serve a large number of Medicaid and uninsured low-income patients, was set to be complete in FY2020. The design of the ACA was for the reduction in DSH payments to be off-set with a reduction in uninsured patients through Medicaid expansion and subsidies for private insurance. Although the implementation of DSH reductions has been delayed until FY2017, additional reductions, including a 2 percent sequestration reduction on Medicare payments, have quickly contributed to the demise of already financially fragile rural hospitals. With this trend expected to accelerate in the future, particularly in non-Medicaid expansion states, some states have begun to discuss alternatives for funding rural hospitals. The most prevalent strategies being discussed for addressing the declining health of rural and critical access hospitals is creating partnerships or mergers with larger hospitals, developing innovative delivery models that rely on integrated healthcare, and expanded utilization of telemedicine in rural areas.
The following information provides details on approaches taken by several SLC states to address the declining fiscal health of rural hospitals, as well as other options that may be worth considering when crafting a solution to address these issues.
Georgia: Rural Hospital Stabilization "Hub and Spoke" Pilot Project In 2014, Governor Nathan Deal announced the formation of the Rural Hospital Stabilization Committee, bringing together policymakers and other stakeholders, to identify the needs of the rural hospital community and provide potential solution for addressing those needs.
February 2015: The Status of Medicaid Expansion in the SLC States
ALABAMA Governor Robert Bentley (R) indicated in December 2014 that he was open to the possibility of Medicaid expansion in the form of a state-designed program that uses private sector insurance and imposes work and job training requirements on the recipients. Governor Bentley has signaled that he may ask the federal government for a block grant to accomplish this expansion. Since the governor’s re-positioning, legislative leaders in Alabama have been relatively quiet on the idea, but Senate President Pro Tem Del Marsh (R) has said he does not think the issue would gain much traction in the Legislature. Support or opposition for the governor’s proposal may become more pronounced in the coming weeks, as legislators get ready to convene the legislative session on March 3, 2015.
ARKANSAS Arkansas has reauthorized funding for its private option alternative to Medicaid expansion through FY 2016. Under additional legislation passed during the 2015 session, the private option expansion will terminate on December 31, 2016, and a newly created legislative task force will make recommendations on alternative coverage models. According to the Arkansas Department of Human Services, as of November 30, 2014, 188,023 individuals have enrolled through the private option program, with an additional 25,117 medically frail individuals enrolled in traditional Medicaid.
How many states have Departments of Elder Abuse and/or Aging?
|State||Division Name||Superior Department||Elder Abuse Services||Website||Elder Abuse Related Service Provision or Referral Department|
|Alabama||Department of Senior Services||Independent||Yes||http://www.alabamaageline.gov/||Elder Justice and Advocacy Program, Interagency Council for the Prevention of Elder Abuse; Refers elder abuse reports to local law enforcement, local Area Agencies on Aging, the Aging & Disability Resource Center, Department of Human Services Adult Protective Services, the Department of Healther, or the Attourney General's Office of Consumer Protection|
|Arkansas||Division of Aging & Adult Services||Department of Human Services||Yes||http://www.daas.ar.gov/||Offers a hotline; Refers elder abuse reports to Department of Human Services Adult Protective Services|
|Florida||Department of Elder Affairs||Independent||Yes||http://elderaffairs.state.fl.us/index.php||Runs elder abuse prevention program, tracks elder abuse reports; Refers reports of abuse to the Florida Abuse Hotline operated by the Department of Children and Families|
|Georgia||Division of Aging Services||Department of Human Services||Yes||http://aging.dhs.georgia.gov/||Houses Adult Protective Services and investigates all reports of abuse|
|Kentucky||Department for Aging & Independent Living||Cabinet for Health & Family Services||Yes||http://chfs.ky.gov/dail/||Elder abuse awareness; Refers reports of abuse to Adult Protection|
How has Medicaid spending changed in the SLC member states in the past three years?
Between FY 2010 and FY 2012, Medicaid expenditures outgrew other areas of state budgets by a large margin in most of the SLC states. In FY 2012, state general fund Medicaid expenditures were an average of 57.4 percent higher in the SLC states than in FY 2010. During this same period, non-Medicaid expenditures only increased by an average of 5.1 percent. Non-Medicaid expenditures include elementary and secondary education, higher education, public assistance, corrections, transportation, and all other non-capital expenditures.
It should be noted, however, that during these fiscal years many states exhausted the use of federal ARRA funds and returned to a lower federal matching rate for Medicaid. During the preceding budget years while states were experiencing reduced revenues, many states used ARRA funds to supplant state funds in order to maintain their level of service; upon exhaustion of the ARRA funds, state funds were necessary to refill these budget holes.
The data for these calculations comes from the National Association of State Budget Officers (NASBO) FY2010-2012 State Expenditure Report and FY 2011-2013 State Expenditure Report. Classification of funds is not uniform across the states; explanations of notable differences are available in the NASBO reports.
|General State Funds||Other State Funds||Federal Funds||Total Funds|
|State Expenditures ($ in millions)||FY 2010||FY 2012||% Change from FY10||FY 2010||FY 2012||% Change from FY10||FY 2010||FY 2012||% Change from FY10||FY 2010||FY 2012||% Change from FY10|
State Efforts to Reorganize and Reform Child Welfare/Social Services Agencies
(The information presented here is in response to a request for details on state efforts to restructure and reorganize the agencies responsible for child welfare services)
For ease of review, this research is presented in three main sections: Section (1) refers to information compiled by the federal government in relation to state efforts to restructure their child welfare services; section (2) deals with information related to the efforts initiated by several states (Alabama, Arizona, Kansas, Pennsylvania and Texas); and, finally section (3), provides details on an important trend that has emerged in the last decade: state efforts to privatize the provision of foster care services. It is also important to mention that our research reveals that over the past 15 years or so, there have been two waves of reform efforts: one that began in the early 2000s and one that is in progress currently.
Section (1) ‐ Federal Information
The trend of social service and foster care reform in our states tends to follow the enactment of federal legislation on the subject. In the early 2000s, many states began to reevaluate and reform their social service and foster care systems. Since that time, numerous studies and reports have been produced chronicling these reforms and their effectiveness. We have provided you with a sampling of assessments of these reform efforts.
Following the enactment of the federal Child and Family Services Improvement and Innovation Act in 2011, the newest wave of social service and foster care reform began gathering momentum. While many states are currently seeking to make changes, whether it is to improve effectiveness or address a specific problem, there is little research on the outcomes to date.
The resources included here provide reports and evaluations that offer examples of what other states have done and are doing with state foster care services. Each resource will provide some information and guidance on the problems, solutions, and outcomes since the turn of the century, encompassing both waves of reforms mentioned at the outset.
How are the SLC member states managing their Medicaid HMO plans?
According to Kaiser Health, approximately 70 percent of all Medicaid enrollees, nationwide, received at least some services through managed care plans. States vary on how they offer health maintenance organization (HMO) plans to enrollees. Some offer HMO plans to all enrollees, while others restrict them to certain populations. The most common populations for expanding access to managed care are children and pregnant women, but many states are expanding to include less healthy populations, such as the elderly and disabled – some of the most expensive Medicaid enrollees. Regardless of the population, the greatest advantages documented by states in moving toward more managed care are associated with costs and consolidated caseloads.
Under fee-for-service systems, states pay each provider for every service they perform. More services lead to more fees and higher costs. Also, fee-for-service systems lend to the ability to commit fraud, because the state pays first and asks questions later. Under the managed care system, however, insurance companies receive a capped amount to serve a patient. Also, proponents claim that HMOs can provide better care through coordination among doctors, hospitals and other medical professionals. Fee-for-services systems often lack coordination, which leads to inconsistent care, particularly for those with chronic conditions, resulting in bad outcomes for patients and heftier, repetitive charges to the state.
Which SLC states have implemented policies to reduce early elective deliveries for Medicaid and SCHIP recipients?
According to a University of Minnesota study published in the American Journal of Public Health, the average cost of Cesarean, or C-section, births is on average approximately $10,000 more expensive than vaginal births ($27,866 versus $18,329 in 2010). Among Medicaid births, the average costs are $9,100 for a vaginal birth, as opposed to $13,600 for a C-section. Considering state Medicaid programs pay for almost half of all U.S. births, there is substantial money to be saved through policies that discourage unnecessary C-sections. One popular policy is to remove financial incentives for unnecessary C-sections by equalizing Medicaid payments for both procedures. In most states, reimbursement policy seems to favor C-sections. Since the procedure accounts for approximately 45 percent of the $86 billion the United States spends on childbirth each year, a reduction in the prevalence of C-sections could mean huge savings for states. Here are some examples of policies SLC states have enacted to address this issue.
|State||Medicaid Payment Strategies||Collaborative Strategies|
|Alabama||Alabama Perinatal Excellence Collaborative (APEC), a collaboration of the University of Alabama Birmingham, the University of South Alabama, Alabama Medicaid and statewide OB providers and hospitals, serves as resource for obstetric and other healthcare providers throughout the state of Alabama for assistance in improving perinatal outcomes. APEC released guidelines to assist providers and facilities in implementing systems to decrease the rate of early elective deliveries.|
|Arkansas||Medicaid Inpatient Quality Incentive Program: incentive for meeting threshold levels on elective delivery measure.||Arkansas Health Care Payment Improvement Initiative: Partnership of Arkansas Medicaid, the Arkansas Department of Human Services, Arkansas Blue Cross and Blue Shield, and Arkansas QualChoice to transform health care in the State. Defined episodes of care for Perinatal conditions for which incentive payments are provided based on thresholds.|
Healthcare Reform: Exchanges and the Expansion of Medicaid
In the world of politics, there are few simple problems and fewer simple solutions. However, some problems are more complex than others, as well as their corresponding solutions. Whether or not to build a certain bridge may invoke varying arguments for or against the project, but when the decision is made, there are a limited number of options for how to move forward. Not so with healthcare in America. There may be some tenets most Americans can agree upon but, beyond that, the solutions become more complicated. For instance, most agree that every American needs access to healthcare, in some form or fashion, but how to accomplish that is where the water gets murky. More precisely, unlike building a bridge, each answer to the problem comes with its own set of positive and negative economic and public health consequences.
Part of the difficulty in arriving at a solution is the sheer scope of the problem. The United States pays more per capita in healthcare than any other country, spending a staggering $7,538 per person per year. Norway is a distant second, at $5,003 per person, according to statistics from the Kaiser Family Foundation. The nation's healthcare spending was estimated at $2.7 trillion last year and is slated to surpass $3 trillion in 2014, according to a report by Bloomberg News. And as the cost of delivering healthcare continues to rise, the number of uninsured continues to grow, premiums continue to escalate, benefits shrink, employees continue to lose insurance through their workplace, employers continue to struggle with the cost of offering sufficient coverage and many people avoid or prolong care due to cost.
What are the grandparental visitation rights in the SLC member states?
The custody statute requires courts to consider the moral character of the parents and the age and sex of the child to determine the best interests of the child. Conditions for grandparent visitation rights include a determination of whether a parent is deceased, the child's parents are divorced, or the grandparent has been denied visitation. Adoption cuts off all visitation rights of grandparents. At least one Alabama Court of Appeals ruled the Alabama statute providing grandparental visitation unconstitutional.
The custody statute requires that court grant custody "without regard to the sex of the parent but solely in accordance with the welfare and best interest of the children." Conditions for grandparent visitation rights include several circumstances where the grandchild has resided with the grandparent, the child's parents are divorced, the child is in the custody of someone other than a parent, or the child has been born out of wedlock. Adoption cuts off all visitation rights of the natural grandparents.
The Florida Supreme Court has ruled the Florida statute providing grandparental visitation unconstitutional, and the Florida Legislature has not adopted an alternative statute.
The custody statute does not list specific factors for the court to consider for determining the best interest of the child. A court may award visitation rights if an action is pending where there is an issue involving the custody of a minor child, divorce of the child's parents, termination of a parent's rights, or visitation rights. Adoption cuts off the visitation rights of the grandparents unless the adoption is granted to a stepparent or a natural relative of the child.
A court may award visitation rights if visitation would be in the child's best interest. A court may award a grandparent the same visitation rights as a parent without custody if the grandparent's child is deceased and the grandparent has provided child support to the grandchild. Adoption cuts off the visitation rights of grandparents unless the adoption is granted to a stepparent, and the grandparent's child has not had his or her parental rights terminated.
How are public health services organized in the SLC member states?
What percentage of children eligible for SCHIP services are covered in SLC states?
Even as states have struggled to meet their Medicaid obligations in recent years due to the downturn in the economy, most have continued to increase the percentage of children covered under the State Children's Health Insurance Program (SCHIP), the predominantly federally funded program that, since 1997, has helped states provide health insurance to children of families that make too much money to qualify for Medicaid but not enough to afford insurance. More importantly, states have worked to ensure that more eligible children are signed up to receive services by developing and promoting programs providing access to eligibility and enrollment information, particularly in rural areas; lengthening enrollment periods without the need for reauthorization; and other measures. According to a recent study by the Robert Wood Johnson Foundation, Gains for Children: Increased Participation in Medicaid and CHIP in 2009, these efforts are working. Nationally, 30 states boosted enrollment of children who are eligible for the program in 2009, the most recent year that data are available, which increased coverage from 80 percent in 2008 to 85 percent in 2009. This increase accounts for an additional 2.5 million children (from 40.2 million in 2008 to 42.7 million in 2009) in all states now covered by the program. It is, in part, attributable to the expansion of Medicaid coverage to individuals with incomes below 138 percent of the federal poverty level, a key component of the Affordable Care Act, as well as the reauthorization of SCHIP (CHIPRA) in 2009, which included grants to develop programs for increasing enrollment. Four SLC states – Arkansas, Kentucky, Tennessee and West Virginia – reported that at least 90 percent of all eligible children were signed up for the program in 2009, and the SLC average for coverage rose from 83.4 percent to 86 percent during that year.
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Prospective Changes in Long-Term Care Policies
According to the federal Centers for Medicare and Medicaid Services (CMS), there are approximately 9 million people in the United States who require long-term care, including those in nursing homes and people with disabilities. That number is expected to reach 12 million by 2020.In addition, approximately 40 percent of all people living in the United States who reach the age of 65 will enter a nursing home at some point in their lives, and 10 percent of all those who do so will stay there five years or more, according to CMS.
Funding for these services is of grave concern to states and the federal government, particularly in light of the national financial crisis and the reality that healthcare costs are expected to double by 2020.Generally, Medicare does not pay for long-term care but only for medically necessary services like home healthcare or skilled nursing facilities, which means Medicaid is primarily responsible for covering most long-term care expenditures, including nursing home care for elderly people. Since Medicaid eligibility requirements vary so widely by state, to what extent these services are funded varies as well.
A Prescription Drug Epidemic
A study by the Substance Abuse and Mental Health Services Administration found that treatment admission for prescription pain pill abuse has quadrupled nationally in the past decade, and that this increase spans every age, gender, race, ethnicity, education, employment level and region of the country. The National Institute on Drug Abuse reports that about 20 percent of people in the United States, or 48 million, have used prescription drugs for nonmedical reasons. Even more alarming, according to a report by the Centers for Disease Control and Prevention, overdoses from prescription drugs in the United States doubled from 1999 to 2007, and each year more than 20,000 people die from overdoses, far more people than are killed by controlled substances like cocaine and heroin. In addition, the South has one of the highest rates of overdose related to prescription drug abuse and misuse.
National Drug Control Policy Director Gil Kerlikowske has called prescription drug abuse the nation's "fastest-growing drug problem," and last month he revealed a new strategy by the White House to reduce misuse of such drugs by 15 percent in five years through a nationwide education campaign; training for clinical practitioners; and establishing prescription drug monitoring programs in all 50 states (currently, only 35 states are operating such programs). In addition, the U.S. Food and Drug Administration is asking makers of pain medications to assist in supplying materials that physicians can use while counseling patients on the risks and benefits of using prescription pain medications.
What percentage of residents in the SLC states lack health insurance?
While the South generally is considered to be the unhealthiest region of the country,putting up the highest obesity rates, percentage of people who smoke, and children who do not receive recommended vaccinations, among other health difficulties, [i] it also is oneof the least insured regions of the country. Althoughmost SLC states saw an increase of insured persons from 2007-2008, the percentage of people lacking health insurance currently living in Southern states(18.3%) still far exceeds the national average (15.4%), as well as averages in other regions of the country. The South also contains three of the top fivestates for percentage ofresidents without health insurance. With a healthcare reform debate raging in Congress, SLC states are watching closely to see what measures will be necessary to ensure more of their citizens have insurance and,correspondingly, access to adequate healthcare services
|Total Population||Population with Health Insurance Coverage||Population without Health Insurance Coverage|
|State||2007||2008||Percent Change: 2007- |
|2007||2008||Percent Change: 2007- |
|2007||2008||Percent of 2008 Total Population||Percent Change: 2007- |
Which SLC states have drug recycling programs?
While federal guidelines simply insist that prescription drugs be thrown in the garbage or flushed down a toilet (if the prescription specifies that this is environmentally safe), states have actually done a lot on developing recycling programs.Currently, 38 states in the nation have laws and programs that create prescription drug "recycling," "repository" or "redistribution" mechanisms for unused medications.Generally, these laws include restrictions for ensuring purity and safety of the products, in order to protect the patient that will ultimately obtain the drug.This means that, in general, states require that drugs not be expired; have a verifiable (future) expiration date; not be "controlled substances" (i.e., illegal drugs); and be verified by a state-licensed pharmacist or pharmacy.Also, the person who is to receive the medication must have a valid prescription from his or her doctor.
Below are summaries of the laws that have been enacted in the 15 SLC states.Many states (e.g., Louisiana, Missouri) first passed laws that authorized the practice of redistributing medications, and then went back and actually created programs to collect and redistribute the drugs from and to the appropriate entities.Alabama, North Carolina, South Carolina, and West Virginia currently do not have legislation pertaining to this issue.In fact, South Carolina has legislation that restricts the practice.North Carolina, however, has been investigating the prospect of creating a program. Where available, the bill numbers have hyperlinks that can be clicked to view the full text of the legislation.
|Arkansas||In 2005, the state passed a law (HB1031) that allows reuse of drugs that are in their original sealed or tamper-resistant packaging. Donated medications can only come from nursing facilities, and they can only be distributed through charitable clinic pharmacies to appropriately screened and qualified indigent patients who are not eligible for Medicaid but cannot afford private health insurance.|
What is the extent of SCHIP programs in the SLC states?
The federal State Children's Health Insurance Program(SCHIP) was created in 1997 to provide health insurance to children of working families with incomes too high to qualify for Medicaid, but too low to afford insurance, in all 50 U.S. states. At the time, it was the single largest expansion of taxpayer-funded insurance coverage for children in the United States since the inception of the Medicaid program during the 1960s.The program is administered by the U.S. Department of Health and Human Services, and approximately 73 percent of the funding for the program comes from the federal government. In 2006, the program covered around 6.6 million children nationally, with some states having designed policies that extended eligibility for some parents of children receiving benefits as well as pregnant women and other adults. The most recent reauthorization of SCHIP by Congress was in February of this year. There are currently 9 million children in the United States without health insurance.
Since the program has proven to encourage people to continue working while alleviating the pressure to find insurance for children of working families, many states have raised the threshold for eligibility in recent years. When the program began, most Southern states set the qualifying ceiling to correspond with the federal poverty level (FPL), i.e., at 100percent of the FPL. The map below illustrates where these eligibility requirements stand today, as well as the number of individuals covered by SCHIP in each of the SLC states. It also indicates the type of SCHIP program administered in each state: entirely separate from Medicaid (s); a combined program with Medicaid (c); or an expansion of Medicaid (e).
Source: U.S. Department of Health and Human Services; Foundation for Health Coverage Education
What is the size of the school-aged population served by the Individuals with Disabilities Education Act? How has the size of this population changed?
The Individuals with Disabilities Education Act (IDEA) requires that school districts that accept federal funding for under the Act to provide appropriate services to children with identified disabilities. Initially passed as the Education for the Handicapped Act in 1975, the legislation has grown in scope and purpose through reauthorizations, including the most recent in 2004. IDEA mandates that students with disabilities be provided with a "free appropriate public education that emphasizes special education and related services designed to meet their unique needs and prepare them for further education, employment, and independent living." (20 U.S.C. § 1400 (d)(1)(a))
Over the past decade, most states have seen considerable growth in the size of the population served by IDEA, both in absolute terms and as a share of the total population. The policy and budgetary implications for this trend are considerable. Because students with disabilities are more costly to serve, school budgets are straining to meet the demands of this population at a time when expenditures on education overall are rising faster than inflation. Furthermore, the rapid rise in this population among schoolchildren complicates planning and policy development processes for schools and states. The table below illustrates the change in this population between 2001 and 2006.
|3- to 21-year-olds served|
|State||2000-01||2006-07||As a percent of public school enrollment, 2006-07||Percent change in number served, 2000-01 to 2006-07|
What trends are SLC states witnessing regarding HIV/AIDS infection?
A recent report by the U.S. Department of Health and Human Services' Center for Disease Control and Prevention shows that there were more than 1.1 million people in the United States living with HIV infection at the end of 2006. The figure is up from 994,000 at the end of 2003, an 11 percent increase. Experts attribute the rise partly to advances in antiviral treatments that increase the life of infected persons. However, the availability of proper education and other preventative measures are a growing concern for states that are experiencing these dramatic increases. Like most regions of the country, SLC states have seen a steady decline in reported AIDS cases since the early 1990s. From July 1995 to June 1996, SLC states reported 24,037 cases of AIDS in the region. From July 2000 to June 2001, states reported only 15,950 cases, a decline of 27 percent for the five-year period. However, that number rose back to 18,946 for the reporting year July 2004 to June 2005. This "fall and rise" trend is represented for most of the 16 SLC states in the chart below. Only Arkansas, Oklahoma, and Virginia saw a decline in reported AIDS cases in the latter comparison.
|State||July, 1995 |
- June 1996
|July, 2000 |
- June, 2001
|% change||July, 2000 |
- June, 2001
|July, 2004 |
- June, 2005
Part I (3 MB)
Regional summary and comparisons
State Profiles (10 MB)
To view individual state reports, click on a state from the map or list below
Which SLC states have passed legislation for the reuse or recycling of prescription drugs?
As the cost of prescription drugs climbs, more of the nation's officials and consumers are weighing how to salvage at least $1 billion worth of unused drugs that are being flushed down the toilet each year.
Though the Food and Drug Administration generally forbids the redistribution of prescription drugs once they are dispensed to consumers, states are free to set their own policies for drugs controlled by nursing homes, long-term-care centers and other pharmacies.
Thus, states have begun to pass legislation to create programs that curb the expensive waste of reusable resources. While the principal argument for these programs is the cost savings to both indigent patients to whom the drugs are often redistributed and the families of the patients who are able to return the medications, there also is a growing concern over the environmental hazards of disposing of prescription drugs in landfills or water systems.
Strom, Stephanie. "Old Pills Finding New Medicine Cabinets." The New York Times. May 18, 2005.
SLC research of Southern states' legislation.
What is the financial impact of chronic diseases on the U.S. economy?
A groundbreaking study ("An Unhealthy America: The Economic Impact of Chronic Disease") released by the Milken Institute in October 2006 detailed the financial impact of chronic disease on the U.S. economy - not only in treatment costs, but lost worker productivity - today and in the decades ahead. As indicated in the study, over 162 million cases of seven common chronic diseases - cancers, diabetes, heart disease, hypertension, stroke, mental disorders, and pulmonary conditions - shortened lives, reduced quality of life, and created considerable burdens for caregivers.
The following map shows how states compare based on the prevalence of the seven common chronic diseases.
The following chart depicts the economic impact of these seven chronic diseases in the SLC states.
Economic Impact of Chronic Diseases in the South
|State||2003 (Annual Costs in Billions)|
|Treatment Expenditures||Lost Productivity|
Part I (3.9MB)
summary and comparisons
to view state reports, click on a state from the map or list below
Entire Report (7.8MB)
Part I (6.7MB)
Regional summary and comparisons
to view state reports, click on a state from the map or list below
Regional summary and comparisons
to view state reports, click on a state from the map or list below
The Southern Regional Project on Infant Mortality: A 20-Year Retrospective
2004 marked the 20th anniversary of the Southern Regional Project on Infant Mortality, a joint effort by the SLC and the Southern Governors' Association. This special series report reviews the successes and failures of the past 20 years and assesses the work of the Project. It also compares statistical data on the various preventative programs and measures available in each state, and highlights the current basic government provisions used to curtail the infant death rate. Get the whole report (2.3MB)
Table of Contents
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