...Health Law, Regulations, and Policy Paper Michelle Hobbs HCS/545 June 13, 2016 Qiana Amos Health Law, Regulation, and Policy Paper Today’s health care industry is more than just providing medical services to individuals in need; it encompasses various laws, regulations, and policies that direct how care should be provided and what the ramifications of non-compliance will have on the health care provider and the organizations where services are rendered. There are various kinds of laws, regulations, and policies that affect the health care industry. Some may believe that laws, regulations, and policies all have the same requirements, benefits, and implications, but there are differences between the three and the impact they have on health care. As the ability of the health care industry continues to expand, the need for additional laws, regulations, and policies will be necessary to ensure the quality and equitable delivery of medical services continues to improve alongside the medical services. Title VI of the Civil Rights Act of 1964 One law that governs the manner in which health care services are rendered is Title VI of the Civil Rights Act of 1964. This law states “no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance (United States Department of Labor, n.d.). For health...
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...Health Law and Regulations Governmental Regulatory Agencies HCS/545 December 16, 2013 Governmental Regulatory Agencies A regulatory agency is a government body formed or mandated under the term of a legislative act to ensure compliance with the provisions of the act, and in carrying out its purpose. “The role of government regulator agencies in health care is to monitor health care practitioners and facilities, provide information about industry changes, promote safety and ensure a legal compliance and quality services” (2013). Health care industry rules and regulations are determined by regulatory agencies, local, federal and state with mandatory oversight. Accreditation agencies require participation that is voluntary because certification of quality provides important ranking. Large private organization and the government help develop and enforce health care regulations. Role Governmental regulatory agencies in health care are the “Food and Drug Administration (FDA), The Agency for Healthcare Research & Quality (AHRQ), The Centers for Medicare & Medicaid Services (CMS), The Centers for Disease Control and Prevention (CDC), and The...
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...owner to seek services from any health care provider. The members of this particular plan do not to limit themselves to either physicians or hospitals under a single network. Under the indemnity plan, the medical bill incurred by the users is sent directly to the health insurance company where a portion of the expenses is paid (LaTour, Maki and Oachs, 2013). For example, the insurance company may pay 80% of the total medical bill where the remaining 20% is paid by the member. Individuals under this plan pay a deductible sum, and once the member has reached the deductible phase, only a small portion is remitted under to the insurance company. The fee for the plan varies from one physician to another an aspect driven by government regulations. Managed care plans Managed care plans refer to a type of health insurance where members have contracts with specific health care providers and medical facilities at a reduced cost. Under this plan, the healthcare provider makes up a planned network of the portion the plan will incur as medical expenses according to the agreed contracts (Cleverley, Cleverley & Song, 2010). As a result of government regulation, managed care plans affect the health care delivery because of financial incentives directed to providers. Government sponsored health plans Under this health insurance policy, various policies cover individual’s health. The policies encompass the following; • Medicare alludes to a federal health insurance program that covers individuals...
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...Health Law and Regulations Paper Veronica Jenkins HCS/544 May 26, 2014 Professor: Kelly Gantt In the health care industry, regulations play an important role “Through various regulatory bodies, the Department of Health and Human Services (HHS) protects the public from a number of health risks and provides programs for public health and welfare” (fiercehealthcare.com). Implementing these two helps protect health care agencies and also regulate public health on every level. “The Centers for Medicare and Medicaid (CMS), founded in 1965, oversee most of the regulations related directly to the healthcare system” (fiercehealthcare.com). CMS provide numerous programs through the government. The health care industry has numerous regulations in healthcare. One example of laws and regulations facing health care is HIPPA. The transformation from paper charts to electronic records raises a great concern in the breach of security. “In addition, interoperability of systems is expected to create yet more breaches, as information is traded between networks. Laptop theft is the most common type of data breach, accounting for 24 percent of reported breaches, according to HHS. Desktop computers were involved in 16 percent of breaches and portable devices such as smart phones were involved in 14 percent” (beckershosiptalreview.com). Human and Health Service (HHS) require individual to notify patients when their information was breach. “The regulations, developed...
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...Regulatory Issues in Health Care Fremgen (2009) defines medical laws or actions set by the federal government and the court system that have binding legal force that address legal rights and obligations affecting patients and protecting the individual rights of patients and health care employees. 50 state have statutes for medical practice acts which apply to precisely to the way that medicine is practiced in a particular state. Laws begin as act acts which define the meaning of “practice of medicine” and set the requirements and procedures for licensure. Medical practice acts also establish what can be considered as unprofessional conduct in particular states. Examples of unprofessional conduct include practicing medicine without a license, practicing healthcare or the inability to practice health care while under addiction or mental illness, felony convictions, insufficient record keeping, employing unlicensed persons to practice medicine, and prescribing drugs in excessive amounts. We currently live in a litigious society. Medical providers must balance providing quality and keeping abreast with current health care regulations to protect themselves from health care law suits (Fremgen, 2009). Laws are enforceable rules set by a government authority. An article related to a regulatory issue in health care will be analyzed to reflect how laws affect the regulatory process in health care. The Four Categories of Law Laws fall into different categories which include constitutional...
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...owner to seek services from any health care provider. The members of this particular plan do not to limit themselves to either physicians or hospitals under a single network. Under the indemnity plan, the medical bill incurred by the users is sent directly to the health insurance company where a portion of the expenses is paid (LaTour, Maki and Oachs, 2013). For example, the insurance company may pay 80% of the total medical bill where the remaining 20% is paid by the member. Individuals under this plan pay a deductible sum, and once the member has reached the deductible phase, only a small portion is remitted under to the insurance company. The fee for the plan varies from one physician to another an aspect driven by government regulations. Managed care plans Managed care plans refer to a type of health insurance where members have contracts with specific health care providers and medical facilities at a reduced cost. Under this plan, the healthcare provider makes up a planned network of the portion the plan will incur as medical expenses according to the agreed contracts (Cleverley, Cleverley & Song, 2010). As a result of government regulation, managed care plans affect the health care delivery because of financial incentives directed to providers. Government sponsored health plans Under this health insurance policy, various policies cover individual’s health. The policies encompass the following; * Medicare alludes to a federal health insurance program that covers...
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...Delivery Systems 7/17/2014 Tamika Warford Explain the various government roles in health care and explain your examples. The government’s involvement in the market exists along a continuum. limited government regulation in the system allows businesses to freely compete. This type of system, a system with limited or no regulations, is described by the term laissez- faire, or “ hands off.” At the far right, complete regulation could be characterized by government owning and running the entire health care system and mandating all components from the types of services provided to the prices that clinicians could charge or how much salary clinicians could earn. Examples of a fully regulated system are the National Health Service in Great Britain, the French health care system or the health care system of the People’s Republic of China. According to a study of the cost components of health care, approximately 14.5 percent of the dollars spent on actual use of medical and health care services ($ 339.2 billion of $ 1.34 trillion in personal health expenditures in 2002) in the United States is spent on regulation ( Conover, 2004), and only $ 170 billion of benefit is derived from that government regulation. The roles played by these two different levels of government are dynamic and differ by political ideology. Some believe that to have equitable access to care, the federal government must provide health care or health insurance to all Americans. Others believe that different states...
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...There are several rationales for or against government intervention in or regulation of the health care industry in the United States. This section will focus on the grounds on which government intervention in or regulation of the health care industry in the United States might be justified. The overriding objective in regulation was, and continues to be, rate setting (Folland, Goodman, & Stano, 2010) in the health care industry. Generally, markets are problematic in health care because markets do not provide goods efficiently or equitably. Though markets usually work well, however, there are many circumstances in which market forces, left to them, will fail to maximize economic and social welfare, and, as a consequence, there will be a case for government interventions (Hayes, et al., 2011). Its primary goal is to limit the high price-cost margins that would otherwise be expected (Folland, Goodman, & Stano, 2010), along with promoting the best minimal quality levels while reducing waste and abuse of expenditures. Recent review from Cochrane Database of Systematic Reviews identified four main categories of market failure that might justify government intervention: intervention externalities; imperfect information; demerit goods; time-inconsistent preferences (a situation in which an individual’s preferences change over time without any change in information (Hayes, et al., 2011). An example of demerit good is something that is seen as intrinsically unhealthy, degrading or...
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...Health Law and Regulations Daniel Sanchez Health Law and Ethics/545 August 19, 2013 Mary Cummings Introduction Over the past several decades America has witnessed overwhelming increases in health care cost and a diminishing quality of care. The involvement of government sets the expectations of enforcing laws and regulations on how health care is delivered in the United States of America. Healthcare legislation has been defining regulatory agencies for centuries. The primary existence of these government-regulated agencies is to ensure that laws and regulations are enforced. Access to quality and affordable healthcare is protected through government regulatory agencies. In addition to the escalating cost of healthcare and increasing society’s debt both positive and negative effects has transpired. The pros and cons of improving care and reducing the cost of healthcare has been the goal of regulatory agencies from the beginning. Controlling healthcare cost and delivering quality care is made possible through health care legislation. The following will discuss governmental regulatory agencies and its effects on the healthcare industry. Government Regulatory Agencies and Their Role Federal regulatory agencies are in place to govern issues that impact the people of the United States. These agencies have been in existence for hundreds of years. Situations that impact the American society are inclusive to things that have a direct personal affect on them individually...
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...understand any law in detail at this point in the course, it is important to understand the source of law. Also, it is important to understand how law affects your organization, as well as how your organization complies with legal requirements. Finally, your understanding of the sources of law, and the process of regulation will help you to make good decisions as a health care administrator. The Sources of Law Many people believe that all law comes from the Congress or from state legislatures. They believe that law is synonymous with “statute” which is a particular kind of law – drafted, debated, and voted on by a group of legislators. This is of course, not correct. There are many other sources of law. There is the federal constitution, and the constitution of each state. There is law made through regulatory agencies (administrative law) and there is law made by judicial decision (common law). This combination of approaches and interests leads to the rich fabric that is simply described as healthcare law. Common Law Contract Law: Contract law is at the heart of healthcare delivery. Insurance companies enter into contracts with patients, providers, facilities, and governments (state and federal). Doctors and hospitals enter into contracts with one another. Unions and employers enter into contracts with one another. Contract workers have employment contracts. All equipment in facilities is acquired and maintained through contracts. Most importantly, the doctor patient relationship is...
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...general power to protect the health of its population within its geographic borders as long as the laws do not obstruct the rights of individuals guaranteed by the constitution. The federal government regulates health matters through the powers granted to the federal government in the federal constitution. This allows the federal government to create benefit programs and to indirectly regulate local activities that it would not have the authority to regulate directly. For example, the federal government created the Medicare program to pay for health care for the elderly and disabled, and Medicaid to pay for health care for the poor. Health care institutions that receive federal money in payment for services to Medicare and Medicaid recipients have to abide by federal regulations in order to keep receiving federal funds. According to Pozgar (2012), “a tort law is a civil wrong, other than a breach of contract, committed against a person or property for which a court provides a remedy in the form of an action for damages”. Within the general field of health care there is a good deal of discussion of tort law and health care because tort actions comprise what are more commonly known as medical malpractice or medical negligence actions. A medical malpractice or medical negligence suit can be raised against a physician or health care provider accused of having violated some standard of care that is recognized in the medical industry. A standard of care is simply a minimum threshold...
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...their health. Health is an integral portion of any country. In the United States the system of health care, as well as its delivery is far disparate compared to those of other countries. Unique in every single aspect, the United States is unmatched. Access to health care in the United States is complex. The overall political climate of the United States; including the interest groups, laws and regulations, and the president and Congress are all key factors in access to health care. Now the question remains; what makes a nation? People, are ultimately the backbone of a country. Because of them a country has an economy, culture, defense, education and government. It is the government’s responsibility to...
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...for-profit, not-for-profit, and government financial environments in the health care industry. Compare the similarities and differences between the for-profit, not-for-profit, and government financial environments. | |For-Profit |Not-for-Profit |Government | |Exampl|Hospitals |Hospitals |Veteran hospitals | |es |Clinics |Home health |Long term care | | |Long term care |Long term care |Clinics | |Simila|Make money through daily operations. |Make money through daily |Make money through daily | |rities|Health care organization have |operations |operations | | |contracts with insurers, government, |Nonprofit and government get |Nonprofit and government get | | |payment from government insurance |property tax exemptions. |property tax exemptions. | | |like Medicare & Medicaid, work under |Health care organization have |Health care organization have | | |same health care regulations. |contracts with insurers, |contracts with insurers, | | |Nonprofit and for profit have board |government, payment from |government, payment from | | ...
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...Examining Government Regulations Anonymous HSM/210 Examining Government Regulations The target population I will be examining is the elderly, the first issue is Ozone standards. Based on extensive scientific evidence about ozone's effects the EPA proposed to strengthen the National Ambient Air Quality Standards. This will improve public health protection especially for children and the elderly. The updates also will improve protection for trees, plants and ecosystems. The second regulation to examine is on (CCRC) Continuing Care Retirement Communities. A. CCAC as a Surrogate for Regulation, B. Benefits of Government Regulation, C. Drawbacks of Government Regulation. Continuing Care Retirement Communities are the best option for the elderly and long-term care. They are known for the strategy of having different levels of care in the community setting and the way they provide cost effective care. As they continue to grow and lose the bad reputation for being financially unstable more of our elderly are finding this option attractive. However not all of the elderly population can afford this option, because the cost is too high. The problem has drawn attention from in and outside the industry who want to make CCRC affordable to more of the elderly population. It is well-documented that America's older population is rapidly expanding. "Between 1990 and 2130 the elderly population is expected to double to 65 million people" (DHHS, 1992). As the...
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...coding and billing affects everyone during their lifetime and yet the regulations of medical coding and billing are extremely complex. Examining the history, evaluation, and effect of new regulations and their cost shed light on an already complex industry. We will review government regulations, technological advancements, and requirements that providers will face in the near future. We will examine our current systems and how they evolved through time and what they may be in the future. We have reviewed articles from the Medical Billing and Coding Association, the Department of Human and Health Services as well as the Office of the Inspector General. We will review the different types of insurance, how they each affect the process of medical coding and billing and then see what the future will be. Finally we will review what steps we have taken that has allowed a government to be so involved in our healthcare decisions. Thesis Statement Medical Coding and Billing has evolved to a point that it affects everyone at one time or another during their lifetime and has only led to complex rules and regulations that you almost need a degree to understand. From times that Physicians bartered for their services to the government telling them what to charge and insurance companies negotiating the best rate they can get. The history, evolution, and effect that new regulations may have on your healthcare and its cost will be discussed to help bring...
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