MHA6050 WEEK 4 DISCUSSION AND PROJECT INSTRUCTIONS

MHA6050 WEEK 4 LECTURE

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Responsibility for Policy Implementation

It is clear that all three branches of the government play a role in the policy development stage, active participation in agenda setting, and legislation development. Implementing organizations are generally management groups found within the executive branch of the government. They work to carry out the activities detailed by laws enacted by the legislative branch. All three branches of the government—legislative, executive, and judicial—continue to play a role in policy implementation, even though the brunt of the task belongs to the executive branch.

The executive branch encompasses a number of implementing agencies, such as the Department of Health and Human Services (HHS), the Department of Justice (DOJ), the Environmental Protection Agency (EPA), and the Food and Drug Administration (FDA). Many recent health policy initiatives of the Affordable Care Act (ACA) have been implemented by the Centers for Medicare & Medicaid (CMS), one of the primary divisions of the Department of HHS. It is the responsibility of these agencies to coordinate their activities with those at the state level. The legislative branch provides oversight for implementation; that is, to ensure that implementation follows the intent of the law to improve government operations in a variety of sectors. The legislative branch represents the interests of the citizens and, therefore, they are accountable to their constituents to ensure implementation of policies that serve public interest.

As such, Congress holds the power of appropriation; that is, the power to determine the budget for each implementing organization based on their efficacy with implementation. Oversight agencies, such as the Congressional Budget Office and the Government Accountability Office, help facilitate direct conversations between congressional personnel and executive personnel. Finally, legislation and the protocol by which that legislation is implemented may be challenged in the courts, which may hear cases between citizens and implementing organizations. Thus, the judicial branch may be viewed as a referee in disputes over policy implementation.

Role of the Three Branches of Government in Policy Implementation

Review the following branches of government to learn more about them.

Legislative

· Enacting laws and appropriating money for operation

· Delegating legislative powers

· Providing legislative immunity and oversight

Executive

· Implementing and administering public policy enacted by and funded by the legislative branch

· Appropriating powers

· Executing veto power

Judicial

· Interpreting Constitution

· Applying interpretations to controversial cases

Additional Materials

From your course textbook, Health Policymaking in the United States, read the following chapter:

· Policy Implementation and Implementing Organizations

From the Internet, review the following:

· American Government. (n.d.). Policy Making: Political Interactions. Retrieved from http://www.ushistory.org/gov/11.asp

· The WHITE HOUSE. (n.d.). The Executive Branch. Retrieved from https://www.whitehouse.gov/1600/executive-branch

Implementing Agency: Divisions of the CMS

The Center for Medicare is the point agency for activities related to the national Medicare program, policies, and operations. Through the work of this agency, potential problems are highlighted and solutions to improve operations and meet the current needs of beneficiaries are identified. It works closely with the Center for Program Integrity (CPI) to help identify and eliminate fraud and abuse of services. The Center for Medicaid and Children's Health Insurance Program (CHIP) is the point agency for activities related to the national Medicaid and CHIP programs, policies, and operations. This agency partners with states to deliver quality services.

Similar to the Center for Medicare, the Center for Medicaid and CHIP services coordinates with the CPI to help identify and eliminate waste. The Center for Consumer Information and Insurance Oversight helps to set and enforce standards in health insurance to improve access and affordability for all Americans. This agency is charged with providing comprehensive information to the public regarding insurance coverage options and oversees the Internet portal providing comparative pricing data. The Center for Medicare and Medicaid Innovation works to research various methods to improve the quality of and access to timely health services. They help to create new models in service delivery, information maintenance, and payment methods.

The Center for Clinical Standards and Quality provides leadership to develop measurable goals for clinical quality improvement and to coordinate activities with outside agencies. This is the agency primarily responsible for operational refinement. And, finally, the CPI helps to promote positive outcomes through provider audits and policy reviews that reveal necessary modifications. This agency oversees all interactions with key stakeholders: the DOJ, state law enforcement, and other federal agencies. Despite the number of agencies and cooperative efforts, there still remain significant challenges associated with policy implementation. Primary challenges for the CMS include managing the health insurance marketplaces, ensuring appropriate use of prescription drugs, ensuring quality of care, and protecting funds from fraud and abuse.

Additional Materials

From your course textbook, Health Policymaking in the United States, read the following chapter:

· Policy Implementation and Implementing Organizations

Policy Implementation Activities

There are four activities involved in policy implementation: designing, rulemaking, operating, and evaluating. The first activity is designing and it is at this time that there is the establishment of an organizational agenda including prioritizing of tasks, identifying personnel, creating a positive organizational climate, and streamlining decision-making processes. Next in the process of policy implementation is rulemaking, which involves detailed instructions developed by the organization to meet the previously specified agenda items.

Next is the operating activity of policy implementation, which is the conduct by organizations and agencies to accomplish the tasks set forth in the design phase and detailed in the rulemaking phase; these are the actual efforts made to implement a piece of legislation. And finally, evaluating, which requires a systematic collection and analysis of data to help assess the efficacy and appropriateness of a policy, informs any necessary changes in a subsequent modification phase.

Important Activities of Policy Implementation

Review each activity to learn more about it.

Designing

· Establishing the agenda of an implementing organization

· Planning how work will be accomplished

· Organizing the units to perform the necessary work

· Staffing, directing, and communicating

Rulemaking

· Involving development of specific directives by an implementing organization

Operating

· Involving efforts from multiple organizations/agencies

· Undertaking the responsibility to follow the rules established to follow policy

Evaluating

· Collecting, analyzing, and using information

· Posing and addressing questions about policies

Additional Materials

From your course textbook, Health Policymaking in the United States, read the following chapter:

· Policy Implementation Activities: Designing, Rulemaking, Operating, and Evaluating