NURS 8100 Week 8 Discussion Federalism’s Impact on Policy

Walden University NURS 8100 Week 8 Discussion Federalism’s Impact on Policy– Step-By-Step Guide

This guide will demonstrate how to complete the Walden University NURS 8100 Week 8 Discussion Federalism’s Impact on Policy assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NURS 8100 Week 8 Discussion Federalism’s Impact on Policy

Whether one passes or fails an academic assignment such as the Walden University NURS 8100 Week 8 Discussion Federalism’s Impact on Policy depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NURS 8100 Week 8 Discussion Federalism’s Impact on Policy

The introduction for the Walden University NURS 8100 Week 8 Discussion Federalism’s Impact on Policy is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NURS 8100 Week 8 Discussion Federalism’s Impact on Policy

After the introduction, move into the main part of the NURS 8100 Week 8 Discussion Federalism’s Impact on Policy assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NURS 8100 Week 8 Discussion Federalism’s Impact on Policy

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NURS 8100 Week 8 Discussion Federalism’s Impact on Policy

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NURS 8100 Week 8 Discussion Federalism’s Impact on Policy

Federalism challenges and stabilizes public policy by introducing innovation that would otherwise not have been introduced. Understanding it is critical in understanding the current healthcare policy-making entangled in a complex maze of shared and competing powerstructures. In the United States, the impact of federalism is vital, particularly in the healthcare sector, where policies passed at the Federal level have overlapping enactments at the State or local level. Medicare, Medicaid, SCHIPS, and PPACA are all health insurance programs. They are designed to subsidize healthcare for Americans, but their operationalization is based on different factors. For instance, Medicare is a federal health insurance program based on age, while Medicaid is open to needy Americans without age restriction. On the other hand, PPACA introduces rights and protection designed to ensure fairness in health coverage. At the same time, SCHIPS is intended to offer a range to children, and each state administers it under different names. 

 
These policies address the same population’s health needs, but they are differentiated using different names and eligibility criteria. State Health Insurance Assistance Program (SHIP) and Medicare are examples of overlapping healthcare policies because the State and Federal governments offer them. This overlap arises because SHIP gets funding from the Federal government to provide people with Medicare-free coverage at the state level. On one side, it creates better service delivery, mainly because the states better understand the population’s needs (Frankel, 2019). Nevertheless, it results in underexploited economies of scale that impede innovation for better service delivery (France, 2018). Again, given that the beneficiaries of SHIP are already covered under Medicare, it raises questions about why more money is channeled to the States via SHIP. Yet, it could be used to help vulnerable populations without any coverage. 

 
According to Bodenheimer & Grumbach (2020), federalism has sparked controversies in the American healthcare policies’ political contentiousness and divergent interests from the public and private sectors. This creates conflicts that reduce efficiencies in the delivery of services. To streamline these challenges, the stakeholders involved ought to work in harmony so that they can benefit the consumers through efficient service delivery to avoid service duplication (Kennedy, 2017). The policy overlaps between the Federal and State levels are proof of the bureaucracy at both levels of governance. France (2018) notes that the Federal government championed policy initiatives during the liberal period, which changed in the conservative era after power was devolved to the States. Therefore, initiatives by the state can be argued as the best for delivering services to the people. 

References 

Bodenheimer, T., & Grumbach, K. (2020). Understanding health policy: A clinical approach (7thed.). New York, NY: McGraw-Hill Medical. 

France, C. (2018). The form and context of federalism: Meaning for health care financing. Journal of Health Politics, Policy & Law, 33(4), 649-705. doi: 10.1215/03616878-2008-012 

Frankel, M. S. (2019). Commentary: Public outreach by the FDA: Evaluating oversight of human drugs and medical devices. Journal of Law, Medicine & Ethics, 37(4), 625-628. 

Kennedy, E. M. (2017). The role of the federal government in eliminating health disparities. Health Affairs, 24(2), 425-428. 

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Sample Answer 2 for NURS 8100 Week 8 Discussion Federalism’s Impact on Policy

There is no health care without mental health care and “access to mental health services is one of the most important and most neglected civil rights issues facing the Nation” (Haffajee et al., 2019). In the United States, about 1 in 5 people in the United States suffer from a mental health condition, and 10% of children and youth have serious mental health treatment needs. These causes significant functional impairment in their lives, with their peer and most of them being children of color (NAMI, 2015). The COVID-19 pandemic highlighted the need for mental health and mental health parity, when Americans suddenly lost their jobs, experienced financial pressures, and became isolated, and their mental disorder symptoms were exacerbated (Haffajee et al., 2019). 

Many state health policy decisions are made in the context of the US federalist system, where both the federal and state governments share responsibility for administration, funding, and oversight. The two examples of policies that are addressed both at the federal and state level are the Mental Health and Substance Use Disorder Benefits of 1996 and the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 (Haffajee et al., 2019). The State and federal laws attempted to address discriminatory practices in health insurance by creating requirements around parity, with the basic idea that mental health and addiction care should be covered at the same level as other health conditions (Andrews et al., 2019). The Mental Health Parity (MHPA) was the first federal law to create parity standards and was enacted in 1996, to eliminate discriminatory insurance practices, and establish the no disparity principle, in health insurance between mental health and general medical benefits(Mulvaney-Day et al., 2019). In 2003, under President Bush, a parity recommendation was introduced which resulted in the Mental Health Parity and Addiction Equity Act (MHPAEA), adopted in September 2006, and in 2008, the Act was passed (Andrews et al., 2018). The act applied the MHPAEA parity requirements to the existing plans, mandating them to cover preventive services, and mental health screenings, and the individual and small group plans were also required to meet the provider network adequacy standards. The plans also ended the annual and lifetime benefit caps, eliminating medical underwriting in the individual and small-group markets with, stipulations that the insurers could not deny coverage or imposed fines (Busch, 2012). 

What are the advantages and/or disadvantages of this duplication? How does this example reflect the implications of federalism? Provide support from the literature for your position. 

The duplication expanded to cover more people, and about1.2 a million individuals in small group plans were set to receive mental health and substance use disorder benefits. They eliminated historical health coverage differences, between mental health and substance use disorder benefits (Beronio et al., 2013). The policies mandated insurance to cover mental health and substance use disorders, and to provide similar benefits, just like any other medical benefits (Friedman et al., 2017). The plans were positively associated with improved access, and utilization of behavioral health outpatient services, with subsequent increases in spending, driven primarily by the overall increases in utilization (Mulvaney-Day et al., 2019) There was a notable increase of 1000 additional individual psychotherapy visits, which expanded the application of the federal parity to cost-sharing, deductibles, limits on inpatient days, and outpatient visits for services both in, and out of network conditions (Friedman et al., 2017). The disadvantage of the policies was in the implementation, because, unlike most state laws, the federal parity law specifically includes substance abuse treatment services, while state parity laws did not apply to plans, in which the employers assume the risk services like self-insured plans (Busch, 2012). There were concerns expressed that the new federal law would relatively increase the cost, while a study reported continued increased disparities, between the behavioral, and the primary health care coverage, indicating possible evidence of non-compliant insurance practices (Shana, 2020). The mental health services remained insufficient, and in high demand, the root cause being, lack of access, inability to find care, and poor insurance coverage, as the top barriers, to obtaining effective mental health services. The federal law regulated different types of self-insured health plans, while the state-controlled many health insurance plans, which were subjected to different regulations without a way to enforce parity (Shana, 2020). There was a clear lack of oversight, and efforts to ensure compliance with the health plans, with a large number of competing for-profit insurers, which created more variation in parity enforcement.  An example of an implication of federalism is the healthcare fraud where a provider bills a patient for services that were not provided or for inaccurate medical procedures compared to the actual procedures performed. The defrauding of the federal government, an insurer, or a federal or state benefit program is a serious offense at both the federal and state levels and can result in significant penalties, fines, and imprisonment terms when an individual or company defrauds the federal government, an insurer, or a federal or state benefit program (Clark & George, 2017). 

To what degree should the federal government get involved in health care policymaking? Provide concrete examples to support your position.  

The federal government should be fully involved in health care policymaking, because. the free market has often proved that it does not have the interests of the people, its responsibility to preserve and protect the interests of the citizens, by supplementing the market gaps and regulating the market where there was notable inefficiency or unfairness (Schmidt et al., 2017). This involves effective and adequate healthcare laws, regulations, and policies, which had major direct and indirect influences on healthcare delivery (Schmidt et al., 2017). The federal government has the maximal advantage because of its unique position as a health regulator, purchaser, provider, and sponsor of applied health services, to set and implement quality standards for the health care sector (Schmidt et al., 2017). It is through its regulator role that the body establishes minimal health care standards, and effective regulatory requirements to protect the beneficiaries from incompetent, impaired, and inadequately trained clinicians, and from healthcare organizations, which lack the requisite capabilities and processes, to provide the minimal level of quality care (Schmidt et al., 2017). It has a key role in modeling the health care policies to ensure that they are beneficial and fair to everyone in the society, without discrimination by regulating them, while focusing on quality health care improvement. The body also evaluates the care quality with purchasing strategies, to promote the adoption of the best policies, by providing funding and resources to institutionalize quality improvement and patient safety practices (Schmidt et al., 2017).  

References 

 Andrews, C. M., Grogan, C. M., Smith, T. B., Abraham, A. J., Harold A. Pollack, H. A., Humphreys, K., Melissa A. Westlake, M. A., & Friedmann, P. D. (2018). Medicaid Benefits for Addiction Treatment Expanded After Implementation of The Affordable Care Act Health Affairs 2018 37:8, 1216-1222 

Busch S. H. (2012). Implications of the Mental Health Parity and Addiction Equity Act. The American journal of psychiatry, 169(1), 1–3. https://doi.org/10.1176/appi.ajp.2011.11101543 

Beronio, K., Po, Rosa., Skopec, L., and Glied, S. (2013). Affordable Care Act will expand Mental Health and Substance Use Disorder Benefits and Parity Protections for 62 million Americans. Retrieved from http://aspe.hhs.gov  

Clark, K., & George, A. (2017). Home Healthcare and the MEDICARE FRAUD STRIKE FORCE. Home Healthcare Now, 35(10), 549–553. https://doi.org/10.1097/NHH.0000000000000620 

Friedman, S., Xu, H., Harwood, J. M., Azocar, F., Hurley, B., Ettner, S.L. (2017). The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders. DOI: https://doi.org/10.1016/j.jsat.2017.06.006  

Haffajee, R. L., Mello, M. M., Zhang, F., Busch, A. B., Zaslavsky, A. M., & Wharam, J. F. (2019). Association of Federal Mental Health Parity Legislation with Health Care Use and Spending Among High Utilizers of Services. Medical care, 57(4), 245–255. https://doi.org/10.1097/MLR.0000000000001076 

Mulvaney-Day, N., Gibbons, B. J., Alikhan, S., & Karakus, M. (2019). Mental Health Parity and Addiction Equity Act and the Use of Outpatient Behavioral Health Services in the United States, 2005-2016. American journal of public health, 109(S3), S190–S196. https://doi.org/10.2105/AJPH.2019.305023 

National Alliance for Mental Illness (NAMI, 2015). Reinvesting in the community: A family guide to expanding home and community-based Mental Health services and support. Retrieved from http://www.nami.org  

Shana, A, (2020). Mental Health Parity in the US: Have We Made Any Real Progress? J Psychiatric Times, Vol 37, Issue 6, Volume 37, Issue 6 

NURS 8100 Week 9 Discussion Policy and State Boards of Nursing

The goal of the state boards of nursing is protect the safety of the community by ensuring nurses who practice are competent and have received the required training to provide care (Thomas, Benbow, & Ayars, 2010).  Since this scope of practice is defined at the state level, there can be a discrepancy in what nurses are allowed to do state-to-state and the license needed to practice in that state.  There has been tremendous effort to form legislature around the compact nursing license to allow nurses reciprocity in participating states.  However, this is not the standard with advanced practice registered nurses (APRN) (Watson & Hillman, 2010).  In the state of New Mexico, the board of nursing is actively involved in promoting and encouraging the expansion of the APRN Compact (New Mexico Board of Nursing, n.d.).  Currently, the only two states involved in the APRN are Utah, North Dakota, and Delaware (APRN Compact, n.d.).  States not involved in the APRN Compact can vary greatly in terms of scope of practice.  For example, recently in Florida it was passed that nurse practitioners have full practice authority while in many other states that has been the norm for years.  This type of discrepancy can disrupt the distribution of qualified providers across the country due to scope of practice limitations.  Additionally, it can cause confusion among practitioners on what they can/can not do by law.     

            At my organization, the state regulations are supported within my place of employment through the Professional Nursing Practice Department who advocate for state and federal legislature involving nursing and support the state regulations around registered nurses and APRNs.  This department looks at our nurse residency program, nursing credentials, nursing accreditations etc. for the academic hospital.  This department works in collaboration with several other complimentary nursing departments and reports directly to our Chief Nursing Officer.          

References 

APRN Compact. (n.d.) https://aprncompact.com/about.htm  

New Mexico Board of Nursing. (n.d.) https://www.ncsbn.org/policy-and-government.htm  

Thomas, M. B., Benbow, D.A., & Ayars, V. D. (2010). Continued competency and board             regulations: One state expands options.  Journal of Continuing Education in Nursing, 41(11), 524-528.   

Watson, E., & Hillman, H. (2010). Advanced practice registered nursing: Licensure, education,  scope of practice, and liability issues. Journal of Legal Consulting, 21(3, 25-29.