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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