Medicare/Medicaid Law Resource Guide

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Introduction
Statutes & Codes
Regulations & Rules
Treatises & Practice Guides
Journal Articles & Current Awareness Services
Databases
Web Resources

 

See also the Health Law Research guide.

Please contact a research services law librarian for help with locating or using any of the resources discussed in this guide.

 

Introduction

Medicare and Medicaid law concerns the federal government's health insurance program for elderly and disabled persons and persons with end-stage renal disease, as well as the federal and state governments' health insurance programs for persons receiving public assistance.  Topics include government health care appropriations; government trust funds; government payroll taxes; health care cost measurement and cost-effectiveness; health care insurance; health care networks; inpatient hospital, skilled nursing facility, home health agency, home health aide, hospice care, and other medical services coverage and payments; as well as prescription drug and biologicals coverage and payments.   Medicare and Medicaid law research provides particularly rich opportunities for understanding legislative and administrative law.

 

Statutes & Codes

US Code:  Public Health and Welfare 42 USC; Medicare Program 42 USC §1395 et seq.; Hospitals and Asylums 24 USC; Food and Drugs 21 USC
[Links via Cornell Law School's Legal Information Institute; "generated from the most recent version made available by the US House of Representatives."]

Ohio Revised Code:  Medical Assistance Programs ORC §5111 et seq.;  Health-Safety-Morals 37 ORC; Insurance 39 ORC.

 

Regulations & Rules

One of the primary duties of the state is to preserve public health.  Federal health law is concentrated on the U.S. Department of Health and Human Services, which administers numerous agencies and programs such as the Centers for Medicare & Medicaid Services.  Each state has the authority to establish its Medicaid eligibility standards, medical services coverage and payments, and administration.  States administer their Medicaid authority through agencies such as the Ohio Department of Job and Family Services.

Code of Federal Regulations:  Public Health (Department of Health and Human Services)  42 CFR; Centers for Medicare & Medicaid Services, Department of Health and Human Services 42 CFR Chapter IV; Food and Drugs (Food and Drug Administration) 21 CFR Chapter 1.
[Links via GPO Access.]

Ohio Administrative Code:  Department of Job and Family Services - Division of Medical Assistance OAC 5101:3-1-01 et seq.; Department of Health OAC 3701 et seq.; State Certificate of Need Review Board OAC 3702 et seq.; Commission on Minority Health OAC 3704 et seq.; Department of Insurance OAC 3901 et seq.

 

Treatises & Practice Guides

Current health care and medical knowledge is primarily found in the journal literature, and one should never simply rely upon books.  However, books can help one initially understand health law topics, and there are several good health law practice guides.  For treatises and other materials on Medicare and Medicaid, search the SCHOLAR and OhioLINK catalogs with the subject headings Medicare and Medicaid.  See also the Medicare Related Subject Headings and Medicaid Related Subject Headings. .

Selected treatises, practice guides and study aids:

The Diagnosis and Treatment of Medicare / Andrew J. Rettenmaier and Thomas R. Saving.  AEI Press, c2007.  RA412.3 .R4798 2007

Healthy Voices, Unhealthy Silence:  Advocacy and Health Policy for the Poor / Colleen M. Grogan and Michael K. Gusmano.  Georgetown University Press, c2007.  RA412.3 .G76 2007eb (ebook)

Medicaid and Medicare.  Ohio State Bar Association CLE, c2008.  KFO341.5 .P65 M42 2008

Medicaid Planning:  Live Simulcast.  Ohio State Bar Association CLE, c2009.  KFO341.5 .P65 M42 2009

A Practical Guide to Medicare Appeals / Kathleen Scully-Hayes and Daniel A. Cody. ABA Pub., c2007.  KF3608 .A4 S38 2007

Medicaid, SNTs and Pensions:  and Medicare. Ohio State Bar Association CLE, c2007.  KFO341.5 .P65 M43 2007

Ohio Elder Law.  West, c2012.  KFO91 .A3 O365 2012
 

Journal Articles & Current Awareness Services

See the Finding Articles in Law Reviews and Journals guide for an explanation of the legal periodical indexes and databases available to Cleveland-Marshall College of Law students and the CSU community.  That guide covers print and electronic indexes, as well as electronic full-text journals.  In particular, note OhioLINK's Electronic Journal Center and its Health Sciences and Medicine subject cluster.

When searching medical and health care journal literature, note that, in addition to supporting keyword searching, the indexing and abstracting services for this literature tend to use thesauri or controlled vocabulary.  This means human beings are involved in the indexing and abstracting of this journal literature, resulting in extremely detailed and precise databases.  In general, medical and health care literature indexing and abstracting services do not provide full-text documents.  However, several do provide links to full-text document services, and many medical and health care journals are available electronically.
MeSH (Medical Subject Headings) is the thesaurus used by the U.S. National Library of Medicine in its databases, such as PubMed.  Use MeSH to identify medical and health care terminology.  This terminology will help you construct more effective search statements in legal (as well as medical and health care) periodical indexes and databases.

In general, health/medical indexing and abstracting services do not provide full-text documents.  However, many provide links to full-text document services, and many journals are now available electronically.

 

Databases

BNA Health Law Resource Center
Analysis, news, and primary law.  Titles include  Fraud, Abuse & ComplianceHealth Insurance & BenefitsHospital & Provider Regulation,  and  Medicare & Medicaid.   C|M|Law students and faculty can also sign up for BNA Current Awareness Services.

CCH IntelliConnect
Health Law related materials are grouped under  Food, Drugs, and Devices  and  Health Care Compliance and Reimbursement.  Titles include Medicare and Medicaid Guide and CMS Program Manuals.  Click here for a full list of CCH titles.    To sign up for current awareness emails on a variety of topics, log on then click on Tracker News (at upper left), then follow the prompts and directions.

LexisNexis
Area of Law - By Topic > Health Care  - and -  Area of Law - By Topic > Medical
50 State Surveys, Legislation & Regulations -  select Health, then browse or search.

Westlaw
Topical Materials by Area of Practice:  Health & Medicine
50 State Surveys (SURVEYS)
KeySearch:  Health and Insurance sections.

 

Web Resources

 

U.S. Department of Health and Human Services:  Centers for Medicare and Medicaid Services

U.S. Department of Health and Human Services:  Medicaid.gov

U.S. Department of Health and Human Services:  Medicare.gov

U.S. Social Security Administration:  Medicare

Ohio Department of Insurance:  Consumer Affairs:  Services for People on Medicare (Ohio Senior Health Insurance Information Program - OSHIIP)

Ohio Department of Job & Family Services:  Ohio Medicaid

Association of State and Territorial Health Officials
Nonprofit organization that assists “state/territorial health agencies develop and implement programs and policies in public health priority areas.” In particular, see its  Programs  and  Research  pages.

 

American Association of Retired Persons:  Insurance & Medicare

American Medical Association:  Current Topics in Advocacy
See in particular the sections on Access to Care and Medicare Physician Payment.

Center for Medicare Advocacy
"A national non-profit organization that provides research, analysis, education, and advocacy to help older people and people with disabilites obtain fair access to Medicare and quality health care."

Medicare Rights Center
“A national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs and public policy initiatives."

National Academy for State Health Policy
“Independent academy of state health policymakers working together to identify emerging issues, develop policy solutions, and improve health policy and practice.” In particular, see its  Health Reform Implementation  and  Programs  sections.

 

Cornell Law School's Legal Information Institute:  Wex:  Medicare  and  Medicaid

Senior Law:  Medicare and Medicaid Updates

 

 

LER 2008; updated 12/11

 

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