HCS 545 Week 2 Health Care Laws Policies and Regulations Presentation

16 Oct No Comments

Health Care Laws, Policies, and Regulations

HCS/545

Introduction

The array of regulations that govern health care can seem overwhelming to people who work in the industry. Almost every aspect of the field is overseen by one regulatory body or another, and sometimes by several. Two specific topics are HIPAA and Medicare and will be identified, a discussion on the influence of regulations and legislative politics, the role of Governmental & Non-Governmental Agencies, and the relationship between law and policy in healthcare.

HIPAA

Health Information Portability and Accountability Act of 1996 Requires U.S. Department of Health and Human services to adopt national standardsElectronic health care transactionsNational provider identificationUnder Provisions of Affordable Care Act of 2010Electronic Funds TransferElectronic Remittance AdviceElectronic Claim Attachments

Medicare

President Lyndon Johnson signed Medicare into law on July 30, 1965 (Oberlander, 2015).Citizens qualified for coverageIn1965 and after Persons 65 or older In 1972 and afterPersons with certain permanent disabilitiesPersons with end-stage renal stage illness

Medicare Plans

Part ACovers hospital inpatient, critical access hospitals, hospice, and some home health careMost premiums paid through payroll taxes from workingPart BCovers physicians, outpatient facilities, physical and outpatient therapistsBeneficiaries pay a premium Also responsible for deductible and co-insurance Part CCovers Managed Care and Medicare Advantage PlansPart DCovers Prescriptions Drug Coverage

The influences of regulations and legislative politics

Bringing about policy changeBeginning stepsPublic EventsRemoval of flawsSets a CourseAction planThree phasesFunction of plan

The influences of regulations and legislative politics

Reason for planInsurance companiesEHRHIPAA

The Role of Governmental & Non-Governmental Agencies

HIPAAOffice of Civil RightsPrivate Organizations (e.g. hospitals, insurance companies, etc.)

The Role of Governmental & Non-Governmental Agencies

Emergency Medical Treatment & Labor Act (EMTALA)Governmental Agency – MedicareNon-Governmental Agency – Private hospitals and clinics

Relationship between Law and Policy in Health Care

HIPAAWho must follow these lawsInformation protectedPatient rights to informationWho can review and receive information

Relationship between Law and Policy in Health Care

MedicareInformation protectedRight to get your informationReceive and obtain information

References

References




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