Search

The potential exists for pharmacists to be liable even beyond the accurate dispensing of medications. This article will explore a pharmacist's duty to warn patients about the adverse consequences that [...]

INTRODUCTION Since the inception of the Medicare Program, beneficiaries have purchased individual supplemental insurance--known as Medigap--which reimburses for Medicare cost sharing and selected services that Medicare does not cover. An [...], The 1990 Medigap reform legislation sought to make it easier for consumers to compare policies, provide market stability, promote competition, and avoid adverse selection. Evidence is that the standardization of benefits has simplified consumer choice and is strongly supported by consumers and State regulators. The 1990 reforms also decreased carrier and agent abuses. However, loss ratios (the proportion of premiums paid in benefits versus being retained for administration and profit) have changed little since 1990, bringing into question whether price competition has been enhanced. The prescription drug benefit, which is included in 3 of the 10 standardized plans, provides only limited financial protection yet is expensive, one reason being adverse selection. Access to coverage for Medicare disabled beneficiaries is problematic in most States.

The Omnibus Budget Reconciliation Act of 1990--better known as OBRA '90--was supposed to change the face of pharmacy forever. Medicaid patients were finally going to get complete information on how [...]

Tax purification in the Omnibus Budget Reconciliation Act of 1990 had the unintended consequence of penalizing nonprofessional gamblers because their tax benefits phase out based on how much was won without being measured against losses. Under the pre-1990 system, gamblers measured gains against losses to determine their total loss or gain but under the Act, what is won is included in gross income and so subject to the phase-out of benefits while losses are only deducted after the phase-out has taken effect. This can lead to significant increases in gamblers' tax liability.

President Clinton's veto of the 1995 reconciliation bill, the largest and most ambitious such legislation ever passed by Congress, was the first time a reconciliation bill was ever rejected by a president. It was also the first reconciliation bill in two decades to include a tax reduction rather than a tax increase. The fate of this bill, and its scope and contents, suggest the need to assess the evolution of reconciliation within the congressional budget process. In the early 1980s, Congress altered budget reconciliation procedures, putting in place a powerful new capability for deficit reduction. Reconciliation became the primary means within the budget process of restraining entitlement spending and increasing taxes as part of congressional efforts to reduce the deficit. Gramm-Rudman-Hollings magnified certain problems Congress encountered in using reconciliation to control entitlements, producing increased pressure to cut discretionary spending. While the Budget Enforcement Act of 1990 included new authority to use reconciliation to restrain entitlements, congressional spending priorities combined with the Peace Dividend to maintain the relative sanctuary entitlement programs have enjoyed. The limits of reconciliation as a deficit reduction tool, both in terms of increasing revenues and curtailing entitlements, are detailed. The inherent procedural advantages accorded to entitlements are contrasted with the treatment of discretionary programs, explaining in part the widening gulf between these two categories of spending. Congress has attempted, without success, to find alternatives to reconciliation. The failure of the seven-year, deficit-eliminating reconciliation bill of 1995 may indicate that certain limits on the use of reconciliation may have been reached.

This article reviews the adjustments that have been made to the limits on discretionary federal spending that were enacted as part of the Budget Enforcement Act of 1990. Each type of adjustment authorized by that act is described, and the actual adjustments made by the U.S. Office of Management and Budget are discussed. Tables that display the amounts and timing of the adjustments are used to support the narrative. The article also discusses the relationship of cap adjustments to changes in the federal budget deficit.

Pharmaceutical care and OBRA '90 In 1990, an article appeared in the American Journal of Hospital Pharmacy introducing a concept referred to as pharmaceutical care. That same year, the United [...]

'I'm almost dead from exhaustion by the end of each day,' complained a pharmacy manager in Ohio. 'I'm being buried by paper. I've contemplated quitting pharmacy even though I'm only [...]

OBJECTIVES This lesson, good for two CE credits, requires a passing grade of 70%. After completion of this article, the pharmacist should be able to: * Explain how pharmacy computer [...]

While most pharmacists are learning to cope with the counseling and prospective drug use review dictated by Medicaid reforms, the Omnibus Budget Reconciliation Act of 1990 packs some other provisions [...]

Patients who fail to take their medication properly, or at all, are creating big problems for themselves and the country. The numbers are well known, but they're still numbing: More [...]

The federal budget process was significantly enhanced by the Budget Enforcement Act (BEA) of 1990. Deficit and spending targets, sequester provisions and adjustment clauses are the important fetures of the BEA. This law can be an efficient complement to the deficit reduction efforts of the new administration and Congress, particularly with its compatibility to the categorization of discretionary spending and the introduction of caps to mandatory expenditures.

The enactment of Chapter 14 of the Omnibus Budget Reconciliation Act of 1990 resulted in the extinguishment of many traditional estate freeze planning techniques while giving taxpayers more exact rules and limitations to work with. The new rules are complicated, contain special limitations of actions and are less effective than traditional estate freeze techniques. Two ways to circumvent the new rules are the SUPERFREEZE, which is a sale by installment to a trust that is income tax defective, and the DOUBLEFREEZE, which adds a preferred interest entity freeze.

The purpose of this article is to summarize and discuss the most important aspects of the new federal legislation that mandates expanded standards of practice in patient counseling, to suggest [...]

The day pharmacists have talked about for two years has arrived, and the practice changes mandated by the Omnibus Budget Reconciliation Act of 1990 are now a fact of life. [...]

Investment activity in both residential and commercial sectors of real estate is heavily influenced by tax law provisions. While preferential provisions still remain, the traditional stimulus provided to the real estate industry through preferential tax treatment of long-term capital gains was eliminated by the Tax Reform Act of 1986. More recently, the Revenue Reconciliation Act of 1990 reduced the maximum tax rate on long-term capital gains income. Although the 1990 tax act seemingly represents at least a partial reintroduction of more favorable tax treatment of long-term capital gains, the effective tax is higher than the new nominal maximum rate as a result of interactive provisions contained elsewhere in the act. (Reprinted by permission of the publisher.), In the past few years, Congress has passed increasingly complex tax statutes under the guise of tax reform. In many instances, taxpayers who, as a result of the publicity surrounding [...]

IRC chapter 14 contains many complicated provisions relating to taxation and valuation of buy-sell agreements that make solid tax planning difficult. Buy-sell agreements, both redemption and cross-purchase, can create capital gains, taxable income and the need for estate and transfer taxes. Tax planners must be aware of the Omnibus Budget Reconciliation Act of 1990's valuation rules concerning transfer tax, establish buy-sell agreements that comply with arm's length transaction requirements and carefully document all factual data supporting their positions.

Primary care physicians should provide psychological support for the elderly patient and their caregiver. They must be at hand to train the caregiver on the necessary skills in performing their responsibilities to the elderly patient. Physicians should also be reminded of the presence and consequences of emotional and physical abuse of the elderly. Geriatric management is made more effective by the team approach of physicians, nurses and social workers. Government regulations such as the Omnibus Budget Reconciliation Act affect elderly care by controlling nursing home admissions, health personnel funding and drug prescriptions.

The spilt purchase of personal property could result in tax benefits if the conditions of Section 2702 of the Omnibus Budget Reconciliation Act of 1990. The value-freezing technique has transfer-tax as well as income tax advantages since the tax basis of the second purchaser or remainderman is usually lower. This estate-planning strategy could prove an asset for some clients when they consider buying a residence.

Transfer tax consequences caused by valuation uncertainties can be avoided or reduced using Grantor Retained Income Trusts, Grantor Retained Annuity Trusts and Grantor Retained Unitrusts. They all transfer remainder interests with little or no gift tax consequences, providing significant transfer tax savings. Term interest in the trust is retained by the grantor while the beneficiaries receive the remainder. However, the later two do not decrease in value for transfer tax purposes through a contingent reversionary interest and only some of the transferred property's value will be included in the estate.

The federal government has made surplus pension assets much harder for employers to recover than they once were, but there are still opportunities for employers to use a plan's surplus assets efficiently. The Omnibus Budget Reconciliation Act of 1990 imposes a 50% excise tax on the reversion of pension surplus for employers who terminate plans. Other benefits which the employer has a binding obligation to provide may sometimes be funded with pension surplus. Post-retirement medical benefits are one example as provided for under IRC 401(h). Pension surplus may also be invested in company stock.

Since the enactment of RRA 90, grantor retained income trusts (GRITs), cannot achieve tax-favored results unless the trust is a grantor retained annuity trust (GRAT); a grantor retained unitrust (GRUT); [...]