Department of Health and Human Services Flashcards
Who is the DHHS and what is there primary function?
Principal agency for protecting health of all Americans and providing essential human services
The Federal government’s agency largest grant making agency is called?
Department of Health and Human Services
Name the two main governing bodies effecting healthcare change.
DHHS and Centers for Medicare and Medicaid Serices
There are more than ? programs in DHHS?
300
DHHS leadership and support are provided by whom?
The Office of the Secretary
Where is the DHHS office located?
Washington, DC
What is the acronym AFDC?
Aid to Families with Dependent Children
What does NIH stands for?
National Institutes of Health
FDA?
Federal Drug Administration
CDC?
Centers for Disease Control and Prevention
ATSDR?
Agency for Toxic Substances and Disease Registry
IHS?
Indian Health Services
HRSA
Health Resources and Services Administration
SAMHSA
Substance Abuse and Mental Health Services Administration
AHRQ
Agency for Healthcare Research and Quality
What services are provided by the Office of the Secretary include more than 300 programs can you name nine of them?
Medicare,Medicaid,Financial Assistance(AFDC),Maternal and Infant health, Medical and social science research,Prevention of infectious diseases, including immunization, Drug and Food safety, services for elderly Americans, including home delivered meals, and Child support
Formally known as HCFA
CMS
Administers Medicare and Medicaid
CMS
Name the title for Medicare and Medicaid
Medicare is Title 18 and Medicaid is Title 19
What is CMS Mission
to ensure effective up-to-date healthcare coverage and to promote quality care for beneficiaries.
What does the Healthcare security means?
Access to Affordable and quality healthcare services;protection of the rights and dignity of beneficiaries;provisions of clear and useful information to beneficiaries and providers to assist them in making healthcare decisons
QIO
Quality Improvement Program
What is the purpose of QIO?
monitor and improve utilization and quality care for medicare beneficiaries
The mission for QIO
to ensure quality,effectiveness,efficiency,and economy of healthcare provided to Medicare beneficiaries and reviews all written quality of service complaints submitted by Medicare
Define AOA
Administration of Aging
Define AFDC
Aid to Family with Dependent Children
The Hill Burton Act was passed in 1946 true or false?
True
Explain the HIll-Burton Act
It is the construction loans given to hospital for construction and once completed they exchange for charity. It is also considered a Title 1 sponsored by Senator Harold Burton of Ohio and Senator Lister Hill of Alabama
Explain what CLIA is?
Clinical Laboratory Improvement Amendment
Define PSDA
Patient Self Determination Act
What does PSDA do?
They ensure that patients understand their right to participate in decisions about their healthcare.
What are two examples of PDSA? Explain what they do
A Living Will and a Power of Attorney
Living will is a document that specifies what treatments a patient does and does not wish to receive; it means that difficult decisions about future care are made while the person is alert: Healthcare Power of Attorney or Durable Power of Attorney is a document that designates someone else known as a surrogate or proxy, or agent who make decisions on behalf of the person who can not make a decision regarding their healthcare rights
What is advance directivess
they are a living will and a power of attorney
Explain a patient Bill of Rights
It gives the patient rights that they should receive during their stay at the hospital and healthcare rights.
Name what Patient Rights guarantees
Right to Privacy and Confidentiality lists
- To receive courteous,considerate,respectful treatment.
- Appropriate Healthcare.
- Information about his/her treatment plan in a way that he or she understands
- Continuity of care.
- Confidentiality
- Privacy
- Participation in planning care and treatment
- Refusal of care
- Use of grievance mechanisms
- To receive treatment without discrimination.
- To receive an itemized bill and explanations of all charges.
- Review medical record/and or obtain a copy at a reasonable fee
What is the name of act for Privacy?
The Privacy Act of 1974
The Privacy Act provides?
safeguards against an invasion of privacy through misuse of records by federal agencies.
Define FOIA
Freedom of Information Act
Define HIPPA
Health Insurance Portability and Accountability Act
Another name for the HIPPA is ?
Kennedy-Kassenbaum Bill
What does this Kennedy-Kassenbaum Bill do?
creates federal standards for insurers,HMO’s and employer plans including those who are self insured.
HIPPA Privacy Rule does?
created national standards to protect individuals medical records and other personal health information.
Who established HSA(formerly known as MSAs)
HIPPA
Who regulates clinical licensing
CLIA
Define CLIA
Clinical Laboratory Improvement Amendment
Name two states that are exempt from CLIA
Washington State and New York
HSA
Health Savings Accounts formerly known as MSA(medical savings accounts)
Define EMTALA
Emergency Medical Treatment and Labor Act also known as Federal Anti Dumping Statue.
When was EMTALA enacted?
1986
What are some of the requirements of EMTALA?
Medical screening examination-determines if patient is in a emergency medical condition
2. necessary stabilizing treatment-hosp has to determine if patient is in an emergency condition, they must provide further medical examination and treatment to stabilize the medical condition.
3.Restricting transfer until stabilization. The hospital may not transfer unless the individual requests transfer after having been informed of the hospitals obligation to provide further examination and treatment and of the risks of transfer or a physician certifies in writing that the benefits reasonably expected from treatment at another facility outweigh the risks to the individual or unborn child.
If a physician is not in the emergency room a certification of a qualified medical person.
List the criteria of an appropriate transfer
- Transferring hospital provides medical treatment to minimize risks to the individuals or unborn child.
- Receiving facility has available space and qualified personnel to treat individual and has agreed to accept transfer of the individual
3 Transferring hospital sends all medical records related to the emergency condition including ER medical records, observations of signs, symptoms, preliminary diagnosis, etc.and the name of on call physician who has refused to appear within a reasonable time to provide necessary stabilizing treatment. - Transfer is affected through qualified personnel and transportation equipment, as required including the use of necessary,medically appropriate life support measure during transfer
5 Transfer meets other requirements imposed by DHHS Secretary.
Anti Fraud and Abuse?
People who are not honest
OIG
Office of Inspector General
Who is the Office of Inspector General?
Duties is to control fraud and abuse
What is the purpose of the False Claim Act?
to prohibit a false record or statement of getting a false claim paid or conspiring to be paid by government and they have created fraudulent claims.
Administrative Sanctions consists of?
Determines inappropriate or fraudulent behavior on the behalf of a provider and various administrative sanctions.
1 Denial of the provider number application
2 Suspension of provider payments
3 Application of Civil Monetary Penalties
Define CMP’s?
Civil Monetary Penaties is when a provider or entity has violated Medicare rules and regulations for example unbundling of outpatient surgery costs.
What is the Criminal Health Care Fraud Statue
prohibits willfully and knowingly executing a scheme to obtain any money or property owned by or in control of any health care benefit program or defrauding any health care benefit program
Exclusion of the OIG
Mandatory and permissive
Mandatory Exclusion consists of
Medicare Fraud Patient Neglect Patient Abuse Felonies Health Care related Fraud/HCR theft Financial Misconduct Prescription fraud unlawfully manufacturing,distributing or dispensing controlled substances
Permissive Controlled substances Healthcare Fraud License revocation Suspension of licensure Obstruction of any type of health care investigation Health
