Transdermal fentanyl to methadone conversion ~ Pallimed. The current J of Clinical Oncology has a nice little article about one group's experience converting TTS fentanyl to methadone or vice versa.
Morphine to fentanyl patch conversion FREE subscriptions for doctors and students. 24 hourly oral morphine (mg).
Fentanyl - Wikipedia, the free encyclopedia. Fentanyl. Systematic (IUPAC) name. N- (1- (2- Phenylethyl)- 4- piperidinyl)- N- phenylpropanamide. Clinical data. Trade names.
Actiq, Duragesic, Fentora, others. AHFS/Drugs. com. Monograph.
Pregnancycategory. AU: CUS: C (Risk not ruled out)Dependenceliability. Very high. Routes ofadministration.
Opioid switching from transdermal fentanyl to oral methadone in patients with cancer pain. The starting methadone dose was calculated according to a 2-step conversion between transdermal fentanyl:oral morphine (1:100 ratio. Eastern Metropolitan Region Palliative Care Consortium (Victoria) Opioid Conversion Guidelines 2010 www.emrpcc.org.au . Page 6 of 12 TRANSDERMAL FENTANYL TO MORPHINE Patch Strength Dose Parenteral Morphine equivalent (mg/24. Fentanyl patch (mcg/hr) Buprenorphine patch (mcg/hr) 24 hour oral morphine dose (mg) Breakthrough oramorph dose (mg) 12 <60 5-10 25 35 61-90 10-15 37 52.5 91-134 15-20 50 70 135-224 30 75 105 225-314 40 100 140 315-404 60.
TD, IM, IV, oral transmucosal, sublingual, buccal. Legal status. Legal status.
Pharmacokinetic data. Bioavailability. 92% (transdermal)8.
Protein binding. 80. Fentanyl is estimated to have about 8. Janssen developed fentanyl by assaying analogues of the structurally related drug pethidine for opioid activity. Following this, many other fentanyl analogues were developed and introduced into medical practice, including sufentanil, alfentanil, remifentanil, and lofentanil. In the mid- 1. 99.
During anaesthesia it is often used along with a hypnotic agent like propofol. Fentanyl may be included in a solution along with local anesthetic for neuraxial administration (epidural or intrathecal/spinal). It is also administered in combination with a benzodiazepine, such as midazolam, to produce sedation for procedures such as endoscopy, cardiac catheterization, and oral surgery.
It is often used in the management of chronic pain including cancer pain. The patches work by slowly releasing fentanyl through the skin into the bloodstream over 4. Body temperature, skin type, amount of body fat, and placement of the patch can have major effects. The different delivery systems used by different makers will also affect individual rates of absorption.
Under normal circumstances, the patch will reach its full effect within 1. On Jan 2. 8, 2. 00. U. S. Food and Drug Administration approved first- time generic formulations of 2. In some cases, physicians instruct patients to apply more than one patch at a time, giving a much wider range of possible dosages.
For example, a patient may be prescribed a 3. Although the commonly referred to dosage rates are 1. During the period of June 2. June 2. 00. 3, Duragesic sales totaled over one billion. As of July 2. 00.
Duragesic patch had been changed from the gel pouch and membrane design to . Janssen also later recalled additional lots; a series of Class II Recalls were then initiated in March 2. For both emergency and palliative use, intranasal fentanyl is available in doses of 5. In emergency medicine, safe administration of intranasal fentanyl with a low rate of side effects and a promising pain reducing effect was demonstrated in a prospective observational study in around 9. These lozenges are intended for opioid- tolerant individuals and are effective in treating breakthrough cancer pain. It is most effective when the lozenge is consumed within 1. About 2. 5% of the drug is absorbed through the oral mucosa, resulting in a fast onset of action, and the rest is swallowed and absorbed in the small intestine, acting more slowly.
The lozenge is less effective and acts more slowly if swallowed as a whole, as despite good absorbance from the small intestine there is extensive first- pass metabolism, leading to an oral bioavailability of about 3. In addition, medical personnel are unable to document how much of a lozenge has been used by a person, making drug records inaccurate. An Actiq lozenge contains 2 grams of sugar. Actiq has been linked to dental decay, with some users who previously had no dental issues, having had teeth loss and in the U.
S many users have started their own Facebook page in educating users to the severe dental issues caused by the so called fentanyl lollipops. CBS News reported the issue 2. September 2. 00. 9. The status of a sugar- free version, called Actiq- SF, is unclear. Since the release of Fentora. The lollipop is taped to the casualty's finger and inserted in between the teeth and cheek (buccal area) of the patient.
When enough of the medication has been absorbed the finger will generally fall from the patient's mouth, thereby indicating that the medication has become effectively administered. A wide range of fentanyl preparations are available, including buccal tablets or patches, nasal sprays, inhalers, and active transdermal patches (heat or electrical). In addition, the expense of some of these appliances may greatly reduce their cost- effectiveness. In children it is unclear if intranasal fentanyl is as good as or the same as morphine. Because of fentanyl's high lipid solubility, its effects are more localized than morphine, and some clinicians prefer to use morphine to get a wider spread of analgesia. The war documentary Armadillo (2.
Danish medic who tells of using fentanyl on a severely wounded soldier in Afghanistan. Fentanyl use has also been associated with aphasia. Food and Drug Administration (FDA) began investigating several respiratory deaths, but doctors in the United Kingdom were not warned of the risks with fentanyl until September 2. The patches should be kept away from children, who are most at risk from fentanyl overdose.
The drug was among many identified in counterfeit pills recovered from his home, especially some that were mislabeled as Watson 3. Its strong potency in relation to that of morphine is largely due to its high lipophilicity, per the Meyer- Overton correlation.
Because of this, it can more easily penetrate the CNS. After a set of successful clinical trials, Duragesic fentanyl patches were introduced into medical practice.
Following the patch, a flavored lollipop of fentanyl citrate mixed with inert fillers was introduced under the brand name of Actiq, becoming the first quick- acting formation of fentanyl for use with chronic breakthrough pain. More recently, fentanyl has been developed into an effervescent tab for buccal absorption much like the Actiq lollipop, followed by a buccal spray device for fast- acting relief and other delivery methods currently in development. A fentanyl product has been approved by the US Food and Drug Administration (FDA) for breakthrough cancer pain called Onsolis. It uses a drug delivery technology called BEMA (fentanyl buccal soluble film) on a small disc placed in the mouth. Unlike many other fentanyl products, the drug cannot be abused by crushing and inhaling. Fentanyl has a US DEA ACSCN of 9. Society and culture.
In the U. S., fentanyl is a Schedule II controlled substance per the Controlled Substance Act. Distributors of Abstral are required to implement an FDA- approved risk evaluation and mitigation strategy (REMS) program. This case, the first Federal trial involving the Duragesic fentanyl patch, was tried in the Federal District Court for the Southern District of Florida, West Palm Beach Division. J& J has filed an opposition . The litigation has been ongoing since 2. The trial has been completed. The parties are now drafting and filing their final briefs.
J& J's main argument is that the Dermogesic mark dilutes their Durogesic brand and adds confusion in the marketplace. Obviously, Minnesota High Tech Resources, LLC disagrees with this position. Minnesota High Tech Resources, LLC is a very small biomedical research company owned by two individuals in Red Wing, MN. Public Health Advisories. Food and Drug Administration (FDA) has issued public health advisories related to fentanyl patch dangers. Among these, in July 2. US Food and Drug Administration (FDA) issued a Public Health Advisory.
The reports indicate that doctors have inappropriately prescribed the fentanyl patch.. In addition, the reports indicate that patients are continuing to incorrectly use the fentanyl patch.. United States authorities classify fentanyl as a narcotic and an opioid.
To date, more than 1. U. S. The biological effects of the fentanyl analogues are similar to those of heroin, with the exception that many users report a noticeably less euphoric . Fentanyl is used orally, smoked, snorted, or injected. Fentanyl is sometimes sold as heroin, often leading to overdoses.
Many fentanyl overdoses are initially classified as heroin overdoses. The gel from inside the patches may be ingested or injected. The pharmacy retail price ranges from US$1. US$5. 0 per unit (based on strength of lozenge), with the black market cost ranging from $5. Once the fentanyl is in the user's system, it is extremely difficult to stop its course because of the nature of absorption. Illicitly synthesized fentanyl powder has also appeared on the United States market. Because of the extremely high strength of pure fentanyl powder, it is very difficult to dilute appropriately, and often the resulting mixture may be far too strong and, therefore, very dangerous.
In 2. 00. 6, illegally manufactured, non- pharmaceutical fentanyl often mixed with cocaine or heroin caused an outbreak of overdose deaths in the United States and Canada, heavily concentrated in the cities of Dayton, Ohio; Chicago; Detroit; and Philadelphia. In June 2. 00. 6, 9. Border Patrol agents in California from a vehicle that had entered from Mexico.
However, in April 2. Azusa, California.
The lab was a source of counterfeit 8. Oxy. Contin tablets containing fentanyl instead of oxycodone, as well as bulk fentanyl and other drugs. This results in a drug with an increased duration.
Authorities suspect that the drug is being imported from Asia to the western coast by organized crime groups in powder form and being pressed into pseudo- Oxy. Contin tablets. The drug has been implicated in multiple deaths from the homeless to young professionals, including multiple teens and young parents. The siege was ended, but about 1.
The Russian Health Minister later stated that the gas was based on fentanyl. Its potency and short duration of action make it particularly useful in critically ill patients.
In addition, it tends to cause less vomiting and regurgitation than other pure- opioid agonists (morphine, hydromorphone) when given as a continuous post- operative infusion. As with other pure opioids, fentanyl can be associated with dysphoria in both dogs and cats.
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Sony BMGProducer. Tommy Torres, Sebasti. As a rock musician, Ednita never ceases to amaze with their musical selections. And this time, is joined by some of the most important composers of the industry, including Rafael Esparza, Tommy Thompson, Claudia Brant, Samo (rock pop group Camila), and Mark Portman. Two other producers who collaborate with Ednita to make this project a flawless are Sebastian Krys and Graeme Pleeth. Also the album notched the highest first- week sales for a female Latin act so far this year.
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About the YES Canada Student Exchange Program. Page 1 of 1. 0. Find Your Moment on a High School Student Exchange! On a YES Canada exchange, you will live with a host family, meet new friends at a host high school and explore an exciting new culture. Whether it’s 3 months enjoying the style and fashion in France, 5 months exploring the old- meets- new culture in Japan or 1. Australia, we believe that YES Canada has a program for you. Built on over 1. 5 years of experience and utilizing strong partner relationships throughout the world, we are equipped to provide a safe and rewarding experience that you will never forget.
Our team’s dedication to making your exchange a total success is what we hold paramount and we believe this shines through in the quality of our programs. Welcome to YES Canada, we are waiting to help you find your moment on the trip of a lifetime! Our Selection Criteria for Study Abroad Program. When you go out into the world as a YES Canada student, you take on the important role of ambassador of your own home country, your community and your family. You are representing YES Canada too and we have worked hard to build a solid reputation on the international student exchange. We want your experience to be positive. We want our host families and schools to feel the same.
Foreign Exchange Programs to. They offer academic summer courses for bright 15-18 year olds from.
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Exchange Student Programs. February 0. 4, 2. Read: College students should check with advisors; each university may have its own international exchange program. Costs vary, but you can start researching exchange student programs with this alphabetical list: Exchange Student Programs A- Bcontinue reading below our video Tipping Etiquette Around the World. Rotarians sent over 8.
As a foreign exchange student, you will become knowledgeable about all of these simply by living and studying abroad.
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Speech and Hearing Sciences. Adviser. 21. 0 Eagleson, Box 3. The Department of Speech and Hearing Sciences offers the following programs of study. The Bachelor of Science degree with a major in speech and hearing sciences. An accelerated, fee- based, Bachelor of Science degree with a major in speech and hearing sciences for candidates with an existing bachelor's degree. The admissions committee reviews all applicants based on the following criteria: GPA (minimum 2.
GPA guarantees consideration but not admission); personal statement reflecting an interest in and commitment to speech and hearing sciences; other evidence of a commitment to becoming a speech and hearing sciences major. Students may apply any time after they have earned 7. The application deadline for current UW students is Monday of the third week of the quarter for admission the next quarter; transfer students may apply to the department (if they are at or near junior standing) and to the University concurrently. Admission is for autumn, winter, or spring quarter.
Only students admitted to the UW are eligible for admission to the major. Applicants are notified of the department's decision within four weeks.
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Master of Science in Speech-Language Pathology. Council on Academic Accreditation in speech-language pathology and audiology, accredits the University of New Mexico’s graduate program in speech-language pathology (SLP). Master of Science in Speech-Language Pathology. The graduate speech-language pathology program provides a comprehensive. Welcome to the Department of Communicative Sciences and Disorders in the Phyllis J. Washington College of Education and Human Sciences. Masters Program for Speech-Language Pathology. For information about graduate admissions. The Master’s degree program for speech-language pathology at the University of Florida is accredited by the Council on.
Applications and additional information are available outside 2. Eagleson and on the department's website.
It is appropriate for students with interests in education, healthcare, and communication. This is an intensive program designed to take five quarters with a mandatory summer start. The applicant is responsible for ensuring both the UW Office of Admissions and the Speech and Hearing Sciences Department receive the application materials by the February 1.
Incomplete applications are not processed. Admission to SPHSC is contingent upon admission to UW. The SPHSC recommendation form is available on the department website, depts. However, a letter is acceptable in lieu of the recommendation form. Students should read and fill out the top section of the recommendation form before giving it to the evaluator. See adviser for requirements. No formal internship programs offered.
See adviser for community- based service learning and internship opportunities. Students granted these degrees meet all the requirements of the Certificate of Clinical Competence (CCC) granted by the American Speech- Language- Hearing Association (ASHA), the professional, scientific and credentialing organization for speech- language pathology and audiology professionals. The department does not accept transfer students, Graduate Non- Matriculated (GNM) applicants, or applicants interested in a non- clinical master’s degree. Submit the following to the Speech and Hearing Sciences Department by February 1st.
The Speech-Language Pathology Program at Eastern Michigan University offers both undergraduate and. Can I apply to to the graduate program in Speech-Language Pathology. I would like to become a Speech-Language. The program is accredited by the Council on Academic Accreditation in Audiology and Speech-Language Pathology. Speech and hearing sciences concern the processes. The University Speech and Hearing Clinic and the Center. After you have completed the application for the UM-Leveling program (or Graduate program if. Morgantown, WV West Virginia University Speech Pathology & Audiology. The purpose of the Master of Science degree program in Speech Pathology is to provide aspiring professionals with a firm.
Department's supplemental application. Unofficial transcripts for all schools attended. GRE scores earned within the last five years.
Three letters of recommendation. Personal statement. Minimum 3. 0. 0 GPA for the last 9. English language proficiency as outlined by the UW Graduate School. Bachelor's degree from a regionally accredited institution with a major in speech and hearing sciences (communication disorders, communication sciences and disorders, or a similarly named major) or in another major with sufficient undergraduate coursework in speech and hearing sciences (communication disorders, communication sciences and disorders, or a similarly named program). Prerequisite undergraduate coursework as dictated by the American Speech- Language- Hearing Association's (ASHA) accreditation standards and guidelines. Observations must be under the direction of an ASHA- certified speech- language pathologist.
Students must also successfully complete a written document and oral defense of their thesis. Minimum 1. 8 of the 3. No more than 9 credits of courses 5. The department does not accept transfer students, Graduate non- matriculated (GNM) applicants, or applicants interested in a non- clinical MS degree. Applicants must submit by February 1st. Department's supplemental application. Unofficial transcripts for all schools attended.
GRE scores earned within the last five years. Three letters of recommendation. Personal statement. Minimum 3. 0. 0 GPA for the last 9. Demonstrated English language proficiency as outlined by the UW Graduate School. Bachelor's degree from a regionally accredited institution with a major in speech and hearing sciences (communication disorders, communication sciences and disorders, or a similarly named major) or in another major with sufficient undergraduate coursework in speech and hearing sciences (communication disorders, communication sciences and disorders, or a similarly named program).
Completed prerequisite undergraduate coursework as dictated by the American Speech- Language- Hearing Association's (ASHA) accreditation standards and guidelines. Applicants must have completed a minimum of one course in each of the following areas: Statistics course.
Biological science course (biology, anatomy & physiology, neuroanatomy & neurophysiology, human genetics, or veterinary science)Physical science course (physics or chemistry)Social or behavioral science course (psychology, sociology, anthropology, or public health). Minimum 2. 5 documented, clinical observation hours within the scope of practice of speech- language pathology. Observations must be under the direction of an ASHA certified speech- language pathologist. Students must also successfully complete a written document and oral defense of their thesis. Minimum 1. 8 of the 3. No more than 9 credits of courses 5.
Satisfactory completion of all didactic and practicum requirements detailed above. Students also satisfactorily complete the requirements for the Certificate of Clinical Competence (CCC) of the American Speech- Language- Hearing Association by registering for the required coursework and practica credits. The department does not accept transfer students, Graduate non- matriculated (GNM) applicants, or applicants interested in a non- clinical Au. D degree. Applicants must submit by February 1st.
Departmental's supplemental application. Unofficial Transcripts for all schools attended. GRE scores earned within the last five years. Three letters of recommendation. Personal statement.
Minimum 3. 0. 0 GPA for the last 9. Demonstrated English language proficiency as outlined by the UW Graduate School. Bachelor's degree from a regionally accredited institution. Undergraduate Coursework: Foundational coursework in speech and hearing sciences, as well as the principles of biological science, physical science, social/behavioral science, and basic math or statistics.
All foundational coursework is required for the graduate degree and clinical certification in audiology as dictated by the American Speech- Language- Hearing Association’s (ASHA) accreditation standards and guidelines. The department encourages, but does not require, students to complete this foundation coursework prior to starting graduate study.
Graduates of any Doctor of Audiology program must complete a minimum of one undergraduate course in each of the following areas in order to be eligible for ASHA certification. See advisor for list of acceptable courses. Graduates of the Doctor of Audiology program must also complete undergraduate coursework that covers the following foundational areas in order to be eligible for ASHA certification. Normal development of speech and language. Langauge and speech disorders across the life span. If not completed prior to graduate study, students take one or more of the following speech and language courses during their graduate program: SPHSC 2.
SPHSC 3. 04, SPHSC 3. SPHSC 4. 25. Degree Requirements. Minimum 1. 93 credits: 8. Didactic, minimum 8. SPHSC 4. 62, SPHSC 5. SPHSC 5. 04, SPHSC 5. SPHSC 5. 21, SPHSC 5.
SPHSC 5. 23, SPHSC 5. SPHSC 5. 70, SPHSC 5. SPHSC 5. 72, SPHSC 5. SPHSC 5. 75, SPHSC 5. SPHSC 5. 77, SPHSC 5. SPHSC 5. 80, SPHSC 5. SPHSC 5. 82, SPHSC 5.
SPHSC 5. 84, SPHSC 5. SPHSC 5. 86, SPHSC 5. SPHSC 5. 92, SPHSC 5. A written comprehensive examination in Winter quarter of year three. Students may retake each comprehensive examination only once. Minimum 1. 8 of the 3.
No more than 1. 2 credits of courses 5. Satisfactory completion of all didactic and practicum requirements detailed above. Students also satisfactorily complete the requirements for the Certificate of Clinical Competence (CCC) of the American Speech- Language- Hearing Association by registering for the required coursework and practica credits.
The department does not accept Graduate Non- matriculated (GNM) applicants. Applicants must submit by February 1.
Unofficial transcripts for all schools attended. GRE scores earned within the last 5 years.
Three letters of recommendation. Statement of Purpose. Writing sample or paper. Department's supplemental application. Minimum 3. 0. 0 GPA for the last 9.
Demonstrated English language proficiency as outlined by the UW Graduate School. Bachelor's or master's degree from a regionally accredited institution, depending upon area of interest. Degree Requirements. Minimum 9. 0 credits including: 3. Students may concentrate in basic and applied research.
Courses, seminars, laboratory experiences, and assistantships are selected to provide preparation for careers in research and university or college teaching. Courses that may be used to meet this requirement are: SPHSC 3. SPHSC 3. 05, SPHSC 3.
SPHSC 3. 71, SPHSC 4. SPHSC 4. 61. Students must register for SPHSC 6. In addition, students complete. A pre- dissertation research project (PDP).
Written and oral general examination. Written dissertation based on independent research (minimum 2. SPHSC 8. 00, over 3 quarters) with an oral defense. Teaching Experience: Students pursuing an academic career complete a customized teaching experience plan with their advisory committee. Students also enroll in.
Instructional Development Forum (SPHSC 5. Teaching Practicum (SPHSC 5.
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Self Directed Services . The self- directed service delivery model is an alternative to traditionally delivered and managed services, such as an agency delivery model. Self- direction of services allows participants to have the responsibility for managing all aspects of service delivery in a person- centered planning process. Self- direction promotes personal choice and control over the delivery of waiver and state plan services, including who provides the services and how services are provided. For example, participants are afforded the decision- making authority to recruit, hire, train and supervise the individuals who furnish their services. CMS refers to this as .
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The process is directed by the individual, with assistance as needed or desired from a representative of the individual's choosing. It is intended to identify the strengths, capacities, preferences, needs, and desired measurable outcomes of the individual. The process may include other persons, freely chosen by the individual, who are able to serve as important contributors to the process. The planning process must also include planning for contingencies such as when a needed service is not provided due to the worker being out sick. As part of the contingency planning process, an assessment of the risks to the individual must be completed and a discussion about how the risks will be addressed must be held. Service plan: A service plan is the written document that specifies the services and supports that are to be furnished to meet the preferences, choices, abilities and needs of the individual, and that assist the individual to direct those services and supports and remain in the community. Individualized Budget: An individualized budget is the amount of funds that is under the control and direction of the individual.
A Manual for Person-Centered Planning Facilitators Angela Novak Amado. Community Inclusion, Maine’s University Affiliated Program, University of Maine. California Department of. Individual Program Planning. Person-centered individual program planning assists persons with developmental.
The budget plan is developed using a person- centered planning process and is individually tailored in accordance with the individual's needs and preferences as established in the service plan. States must describe the method for calculating the dollar values of individual budgets based on reliable costs and service utilization, define a process for making adjustments to the budget when changes in participants' person- centered service plans occur and define a procedure to evaluate participants' expenditures. Information and Assistance in Support of Self- Direction: States are required to provide or arrange for the provision of a system of supports that are responsive to an individual's needs and desires for assistance in developing the person- centered service plan and budget plan, managing the individual's services and workers and performing the responsibilities of an employer. Examples of self- directed supports include, but are not limited to: information regarding how a self- directed care program works; individual rights and responsibilities; and available resources; counseling; training; assistance, such as the use of a supports broker/consultant and financial management services (FMS); and access to an independent advocacy system available in the state. The amount and frequency with which an individual uses the available supports varies by person and circumstance.
Support Guidelines. A supports broker/consultant/counselor must be available to each individual who elects the self- direction option.
The supports broker/consultant/counselor supports the individual in directing their services, and serves as a liaison between the individual and the program, assisting individuals with whatever is needed to identify potential personnel requirements, resources to meet those requirements, and the services and supports to sustain individuals as they direct their own services and supports. The supports broker/consultant/counselor acts as an agent of the individual and takes direction from the individual. Financial Management Services.
Financial Management Services (FMS) must be available to assist individuals in exercising budget authority. Individuals can perform some or all of the FMS functions themselves. Typically, however, individuals prefer that the FMS entity performs these functions for them. FMS helps individuals: Understand billing and documentation responsibilities; Perform payroll and employer- related duties (e. Purchase approved goods and services; Track and monitor individual budget expenditures; and. Identify expenditures that are over or under the budget. Quality Assurance and Improvement: Each State Medicaid Agency (SMA) is tasked with having in place a system of continuous quality assurance and improvement.
The system must include activities of discovery, remediation, and quality improvement so that the state learns of critical incidents or events that affect individuals, corrects shortcomings and pursues opportunities for system improvement. The SMA also has overall responsibility for monitoring the system performance measures and individual outcome measures. During the mid- 1. Robert Wood Johnson Foundation awarded grants to develop . These projects primarily evolved into Medicaid- funded programs under section 1.
Act, the home and community- based services waiver program. In the late 1. 99. Robert Wood Johnson Foundation again awarded grants to develop the . These projects evolved into demonstration programs under the section 1. Act. The Deficit Reduction Act (DRA) in 2.
Act. In 2. 01. 0, the Affordable Care Act, passed by Congress and signed by the President on March 2. Act to offer self- directed services.