From: Bill Weissert
To: 684 and 853 Students
1/18/99
Sub: Suggestions for assignment involving regulations and bureaucracy

The Role of the Bureaucracy in Health Policy Making, from Agenda Setting for 
Legislation to Writing Regulations and Taking Other Implementation Steps
Here’s an example showing how to get started to learn how to search for a topic in the 
code of federal regulations to see just what an agency did in interpreting the law as well as 
issues to consider in how the agency carried out its role related to the issue.

	1. Looking at the Regulations
        On the 684/853 class home page 
(http://www.lib.umich.edu/govdocs/healpol.html), 
choose bookmarks, then choose The Code of
Federal Regulations - Select Title
        Scroll down to Title 42, Public Health
        Click on both years : 96 and 97 (to list changes made in either year)
        Scroll down to bottom and click on continue
        At Search Terms, type in Medicaid and hit submit
        Scroll down through the various parts of the code of federal
regulations (the list is topics that have been amended in the past two
years), and look over the kinds of subjects being covered: definitions of
medicaid, eligibility, payment, etc.,
        Choose # 13 42CFR Part 431  State Organization and General
Administration
        Select TXT for text and click on it
        Look over the various subjects covered by this section of the
code.  They implement the part of Medicaid law which tells states how they must 
administer their Medicaid program
        Now go back and choose number 8  42cfr417-- part 417--Health Maintenance 
Organizations,Competitive Medical Plans, And Health Care Prepayment Plans
        This section details how states must run their Medicaid programs
with respect to using managed care plans.  Scroll down and find the
statuatory authority for these regulations. (It’s at the top of the text, bottom of the table of 
contents)
        Move around and see what this section of the regulations covers.
        Note the level of detail in which regulations are written.
        Go back a page and find the regulations relating to quality
assurance in Medicaid programs.

	Now go back to the list of major titles and pick food and drugs.  At the search
prompt, type in food safety.  Look around at the topics covered and the authority. Pick a 
topic and explore it.
	Do the same for another topic of interest to you.  Remember, you must go back to the
	titles listing and choose the major section of the code you want to be in before you
	type in a new search command.
For example, go back and choose Public Health again.
	At the search terms prompt, type in Medicaid Home and Community Based Long Term 
Care
	Look at the topics.  Choose one or two to explore.
	Do the same thing for a topic which interests you.
Describe the kinds of topics covered by the code
and how it implements the law(s).

2. Describing the Agency Culture, Role, Activities and Effectiveness:
 From the textbook, Weissert and Weissert, see how bureaucracy functions and how 
the regulatory process works and the factors which influence the political climate in which 
an agency works.  See also the articles by Wilson and Brehm and Gates and others in the 
coursepack on how bureaucracy works.  Issues to consider regarding the role, capabilities 
and activities of the bureaucracy include:
- reason for participating in this issue: i.e, a statute and mission statement, norms, 
history;
- institutional endowments include scope of the mission, budget, own research 
capability, interest group climate, congressional and presidential support, issue 
saliency and complexity, culture and cohesiveness of the agency, and agency 
support of the goals of the statute;
- activities and effectiveness will include efforts to get issues on the agenda such 
as forming task forces, issuing reports and testimony providing numbers and 
evidence for problem definition, offering solution options, costing out and 
evaluating technical feasibility of solution options and describing their equity 
effects, detailing staff to work with a committee or member on a piece of 
legislation, marshalling interest groups to testify or provide examples and evidence 
on an issue, writing regulations, funding studies, issuing grants or contracts, 
sanctioning violators, fighting other agencies for turf over the issue, adding staff 
and branches, citing reasons why the legislation can’t be implemented, delaying, 
exercising discretion in interpreting the statute in the regulations it writes or other 
actions it takes, the secretary getting into trouble with OMB or the White House. 
        
	
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