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Heat Illness and Death Among Workers — United States, 2012–2013

August 28, 2014 Comments off

Heat Illness and Death Among Workers — United States, 2012–2013
Source: Morbidity and Mortality Weekly Report (CDC)

Exposure to heat and hot environments puts workers at risk for heat stress, which can result in heat illnesses and death. This report describes findings from a review of 2012‒2013 Occupational Safety and Health Administration (OSHA) federal enforcement cases (i.e., inspections) resulting in citations under paragraph 5(a)(1), the “general duty clause” of the Occupational Safety and Health Act of 1970. That clause requires that each employer “furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees” (1). Because OSHA has not issued a heat standard, it must use 5(a)(1) citations in cases of heat illness or death to enforce employers’ obligations to provide a safe and healthy workplace. During the 2-year period reviewed, 20 cases of heat illness or death were cited for federal enforcement under paragraph 5(a)(1) among 18 private employers and two federal agencies. In 13 cases, a worker died from heat exposure, and in seven cases, two or more employees experienced symptoms of heat illness. Most of the affected employees worked outdoors, and all performed heavy or moderate work, as defined by the American Conference of Governmental Industrial Hygienists (2). Nine of the deaths occurred in the first 3 days of working on the job, four of them occurring on the worker’s first day. Heat illness prevention programs at these workplaces were found to be incomplete or absent, and no provision was made for the acclimatization of new workers. Acclimatization is the result of beneficial physiologic adaptations (e.g., increased sweating efficiency and stabilization of circulation) that occur after gradually increased exposure to heat or a hot environment (3). Whenever a potential exists for workers to be exposed to heat or hot environments, employers should implement heat illness prevention programs (including acclimatization requirements) at their workplaces.

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Family Caregivers Providing Complex Chronic Care to People with Cognitive and Behavioral Health Conditions

August 28, 2014 Comments off

Family Caregivers Providing Complex Chronic Care to People with Cognitive and Behavioral Health Conditions
Source: AARP Public Policy Institute

Family caregiving is difficult and stressful. Providing care and support to people with cognitive or behavioral health conditions is doubly challenging. This paper reports on results from a national survey showing that caregivers of family members with challenging behaviors were more likely to perform more than one medical/nursing task, such as managing medications, and often do so with resistance from the person they are trying to help. Yet they receive little or no instruction or guidance on how to do this important work. This analysis offers recommendations for assisting family caregivers who play this dual role.

This is the third “Insight on the Issues” series, drawn from additional analysis of data based on a December 2011 national survey of 1,677 family caregivers, 22 percent of whom were caring for someone with one or more challenging behaviors. Earlier findings were published in the groundbreaking Public Policy Institute/United Hospital Fund report Home Alone: Family Caregivers Providing Complex Chronic Care.
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Recent Declines in Nonmarital Childbearing in the United States

August 28, 2014 Comments off

Recent Declines in Nonmarital Childbearing in the United States
Source: National Center for Health Statistics

Key findings
Data from the National Vital Statistics System and the National Survey of Family Growth

  • Nonmarital births and birth rates have declined 7% and 14%, respectively, since peaking in the late 2000s.
  • Births to unmarried women totaled 1,605,643 in 2013. About 4 in 10 U.S. births were to unmarried women in each year from 2007 through 2013.
  • Nonmarital birth rates fell in all age groups under 35 since 2007; rates increased for women aged 35 and over.
  • Birth rates were down more for unmarried black and Hispanic women than for unmarried non-Hispanic white women.
  • Nonmarital births are increasingly likely to occur within cohabiting unions—rising from 41% of recent births in 2002 to 58% in 2006–2010.

See also: National and State Patterns of Teen Births in the United States, 1940–2013 (_DF)

Affordable Care Act: Improvements Needed to IRS’s Medical Device Excise Tax Program

August 28, 2014 Comments off

Affordable Care Act: Improvements Needed to IRS’s Medical Device Excise Tax Program
Source: Treasury Inspector General for Tax Administration

The Internal Revenue Service (IRS) needs to improve its strategy to ensure accurate reporting and payment of the Medical Device Excise Tax, according to a new report publicly released today by the Treasury Inspector General for Tax Administration (TIGTA).

The Affordable Care Act includes an excise tax equal to 2.3 percent of the sales price for medical devices sold beginning January 1, 2013. Manufacturers, producers, and importers are responsible for collecting the excise tax and must file a Form 720, Quarterly Federal Excise Tax Return. The Joint Committee on Taxation estimated revenues from the medical device excise tax of $20 billion for Fiscal Years 2013 through 2019.

The overall objective of TIGTA’s review was to assess the IRS’s processing of tax returns reporting the medical device excise tax and its efforts to identify taxpayer noncompliance.

TIGTA found that both the number of Forms 720 filed reporting the medical device excise tax and the amount of associated revenue reported were lower than estimated.

The IRS is attempting to develop a compliance strategy to ensure that businesses are compliant with the filing and payment requirements and has taken several measures to advise medical device manufacturers of the new excise tax. However, the IRS cannot identify the population of medical device manufacturers registered with the Food and Drug Administration that are required to file a Form 720 and pay the excise tax.

In addition, processing controls do not ensure the accuracy of medical device excise tax figures reported on paper-filed Forms 720. TIGTA’s analysis of 5,107 Forms 720 processed for the first half of 2013 identified discrepancies in the amount of the excise tax and/or taxable sales amount captured from 276 paper-filed tax returns. TIGTA identified medical device excise tax discrepancies totaling almost $117.8 million when comparing the excise tax amount captured by the IRS from the Form 720 to the excise tax amount that TIGTA calculated.

Finally, the IRS erroneously assessed 219 failure-to-deposit penalties totaling $706,753 against businesses filing a Form 720 for the six months ending June 30, 2013, which was designated a penalty relief period. The IRS had reversed 133 of the 219 penalty assessments. When TIGTA alerted the IRS of the remaining 86 penalties, IRS management reversed the penalties and issued apology letters to the affected taxpayers.

“While the IRS has taken steps to educate medical device manufacturers of the medical device excise tax during implementation, it faces challenges to definitively identify manufacturers subject to the medical device excise tax reporting and payment requirements,” said J. Russell George, Treasury Inspector General for Tax Administration.

TIGTA recommended that the IRS continue refining its compliance strategy to include actions that can be taken to identify noncompliant manufacturers. Additionally, TIGTA recommended that the IRS review the 276 tax returns TIGTA identified to determine the proper excise tax owed, establish a process to verify the accuracy of the medical device excise tax amount for paper-filed Forms 720, and initiate a process to correspond with taxpayers to obtain missing taxable sales or tax amounts.

The IRS agreed with TIGTA’s recommendations and plans to consider alternative strategies for identifying noncompliant manufacturers, identify programming changes needed to improve the math verification for paper-filed Forms 720, and implement procedures for corresponding with taxpayers if the changes can be accomplished within budgetary constraints. The IRS also indicated that approximately two-thirds of the paper-filed tax returns TIGTA identified were reviewed.

Unexplained Deaths in Infancy: England and Wales, 2012

August 28, 2014 Comments off

Unexplained Deaths in Infancy: England and Wales, 2012
Source: Office for National Statistics

Key Points

  • 221 unexplained infant deaths occurred in England and Wales in 2012, a rate of 0.30 deaths per 1,000 live births.
  • Almost three-quarters (71%) of these unexplained deaths were recorded as sudden infant deaths, and 29% were recorded as unascertained.
  • Unexplained infant deaths accounted for 8% of all infant deaths occurring in 2012.
  • Eight out of ten unexplained infant deaths occurred in the post-neonatal period (between 28 days and 1 year).
  • Almost two-thirds (64%) of unexplained infant deaths were boys in 2012 (141 deaths).
  • The rate of unexplained infant death was three times higher among low birthweight babies (less than 2,500g) than babies with a normal birthweight (2,500g and over).

An Overview of 60 Contracts That Contributed to the Development and Operation of the Federal Marketplace

August 27, 2014 Comments off

An Overview of 60 Contracts That Contributed to the Development and Operation of the Federal Marketplace
Source: U.S. Department of Health and Human Services, Office of Inspector General

Summary

WHY WE DID THIS STUDY
The Patient Protection and Affordable Care Act required the establishment of a health insurance exchange (marketplace) in each State. For States that elect not to establish their own marketplaces, the Federal Government is required to operate a marketplace on behalf of the State. A marketplace is designed to serve as a one-stop shop where individuals can obtain information about their health insurance options, determine eligibility for insurance affordability programs, and select the plan of their choice. CMS operates the Federally Facilitated Marketplace (Federal Marketplace). CMS relied-and continues to rely extensively-on contractors to operate the Federal Marketplace. This report is the first in a series that will address the planning, acquisition, management, and performance oversight of Federal Marketplace contracts, as well as various aspects of Federal Marketplace operations. This report provides descriptive and financial data on 60 contracts related to the development of the Federal Marketplace at HealthCare.gov.

HOW WE DID THIS STUDY
CMS identified 60 contracts (“the contracts”) related to the development and operation of the Federal Marketplace. Not all of these contracts were awarded solely for the purpose of the Federal Marketplace. To determine the estimated value of the contracts and the amount obligated for the contracts as of February 2014, OIG analyzed contract, order, and modification documentation provided by CMS for the 60 contracts. We calculated the total obligation and expenditure amounts related to the Federal Marketplace portions of each contract by summarizing the financial accounting transactions that CMS identified as related to the Federal Marketplace for each contract. These financial accounting transactions (obligations and expenditures) include all transactions that CMS processed through its Healthcare Integrated General Ledger Accounting System (HIGLAS) as of February 28, 2014, that CMS had provided to us as of June 18, 2014.

SUMMARY
The 60 contracts related to the development and operation of the Federal Marketplace started between January 2009 and January 2014. The purpose of the 60 contracts ranged from health benefit data collection and consumer research to cloud computing and Web site development. The original estimated values of these contracts totaled $1.7 billion; the contract values ranged from $69,195 to over $200 million. Across the 60 contracts, nearly $800 million has been obligated for the development of the Federal Marketplace as of February 2014. As of that date, CMS had paid nearly $500 million for the development of the Federal Marketplace to the contractors awarded these contracts.

CDC Digital Press Kit: Ebola Outbreak – 2014

August 27, 2014 Comments off

CDC Digital Press Kit: Ebola Outbreak – 2014
Source: Centers for Disease Control and Prevention

CDC is rapidly increasing its ongoing efforts to curb the expanding West African Ebola outbreak and deploying staff to four African nations currently affected: Guinea, Sierra Leone, Liberia, and Nigeria.

This is the largest Ebola outbreak in history and the first in West Africa. The outbreak in West Africa is worsening, but CDC, along with other U.S. government agencies and international partners, is taking active steps to respond to this rapidly changing situation.

CDC elevated its Emergency Operations Center (EOC) to a Level 1 activation, its highest level, because of the significance of the outbreak in West Africa.
CDC is surging our response with the current challenges that we are facing. CDC is sending additional CDC disease control specialists into the four countries.

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