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Federal Regulations & Governing Bodies > Department of Health and Human Services > Flashcards

Department of Health and Human Services Flashcards

1
Q

Who is the DHHS and what is there primary function?

A

Principal agency for protecting health of all Americans and providing essential human services

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2
Q

The Federal government’s agency largest grant making agency is called?

A

Department of Health and Human Services

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3
Q

Name the two main governing bodies effecting healthcare change.

A

DHHS and Centers for Medicare and Medicaid Serices

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4
Q

There are more than ? programs in DHHS?

A

300

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5
Q

DHHS leadership and support are provided by whom?

A

The Office of the Secretary

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6
Q

Where is the DHHS office located?

A

Washington, DC

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7
Q

What is the acronym AFDC?

A

Aid to Families with Dependent Children

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8
Q

What does NIH stands for?

A

National Institutes of Health

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9
Q

FDA?

A

Federal Drug Administration

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10
Q

CDC?

A

Centers for Disease Control and Prevention

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11
Q

ATSDR?

A

Agency for Toxic Substances and Disease Registry

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12
Q

IHS?

A

Indian Health Services

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13
Q

HRSA

A

Health Resources and Services Administration

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14
Q

SAMHSA

A

Substance Abuse and Mental Health Services Administration

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15
Q

AHRQ

A

Agency for Healthcare Research and Quality

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16
Q

What services are provided by the Office of the Secretary include more than 300 programs can you name nine of them?

A

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

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17
Q

Formally known as HCFA

A

CMS

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18
Q

Administers Medicare and Medicaid

A

CMS

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19
Q

Name the title for Medicare and Medicaid

A

Medicare is Title 18 and Medicaid is Title 19

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20
Q

What is CMS Mission

A

to ensure effective up-to-date healthcare coverage and to promote quality care for beneficiaries.

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21
Q

What does the Healthcare security means?

A

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

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22
Q

QIO

A

Quality Improvement Program

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23
Q

What is the purpose of QIO?

A

monitor and improve utilization and quality care for medicare beneficiaries

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24
Q

The mission for QIO

A

to ensure quality,effectiveness,efficiency,and economy of healthcare provided to Medicare beneficiaries and reviews all written quality of service complaints submitted by Medicare

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25
Q

Define AOA

A

Administration of Aging

26
Q

Define AFDC

A

Aid to Family with Dependent Children

27
Q

The Hill Burton Act was passed in 1946 true or false?

A

True

28
Q

Explain the HIll-Burton Act

A

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

29
Q

Explain what CLIA is?

A

Clinical Laboratory Improvement Amendment

30
Q

Define PSDA

A

Patient Self Determination Act

31
Q

What does PSDA do?

A

They ensure that patients understand their right to participate in decisions about their healthcare.

32
Q

What are two examples of PDSA? Explain what they do

A

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

33
Q

What is advance directivess

A

they are a living will and a power of attorney

34
Q

Explain a patient Bill of Rights

A

It gives the patient rights that they should receive during their stay at the hospital and healthcare rights.

35
Q

Name what Patient Rights guarantees

Right to Privacy and Confidentiality lists

A
  1. To receive courteous,considerate,respectful treatment.
  2. Appropriate Healthcare.
  3. Information about his/her treatment plan in a way that he or she understands
  4. Continuity of care.
  5. Confidentiality
  6. Privacy
  7. Participation in planning care and treatment
  8. Refusal of care
  9. Use of grievance mechanisms
  10. To receive treatment without discrimination.
  11. To receive an itemized bill and explanations of all charges.
  12. Review medical record/and or obtain a copy at a reasonable fee
36
Q

What is the name of act for Privacy?

A

The Privacy Act of 1974

37
Q

The Privacy Act provides?

A

safeguards against an invasion of privacy through misuse of records by federal agencies.

38
Q

Define FOIA

A

Freedom of Information Act

39
Q

Define HIPPA

A

Health Insurance Portability and Accountability Act

40
Q

Another name for the HIPPA is ?

A

Kennedy-Kassenbaum Bill

41
Q

What does this Kennedy-Kassenbaum Bill do?

A

creates federal standards for insurers,HMO’s and employer plans including those who are self insured.

42
Q

HIPPA Privacy Rule does?

A

created national standards to protect individuals medical records and other personal health information.

43
Q

Who established HSA(formerly known as MSAs)

A

HIPPA

44
Q

Who regulates clinical licensing

A

CLIA

45
Q

Define CLIA

A

Clinical Laboratory Improvement Amendment

46
Q

Name two states that are exempt from CLIA

A

Washington State and New York

47
Q

HSA

A

Health Savings Accounts formerly known as MSA(medical savings accounts)

48
Q

Define EMTALA

A

Emergency Medical Treatment and Labor Act also known as Federal Anti Dumping Statue.

49
Q

When was EMTALA enacted?

A

1986

50
Q

What are some of the requirements of EMTALA?

A

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.

51
Q

List the criteria of an appropriate transfer

A
  1. Transferring hospital provides medical treatment to minimize risks to the individuals or unborn child.
  2. 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.
  3. 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.
52
Q

Anti Fraud and Abuse?

A

People who are not honest

53
Q

OIG

A

Office of Inspector General

54
Q

Who is the Office of Inspector General?

A

Duties is to control fraud and abuse

55
Q

What is the purpose of the False Claim Act?

A

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.

56
Q

Administrative Sanctions consists of?

A

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

57
Q

Define CMP’s?

A

Civil Monetary Penaties is when a provider or entity has violated Medicare rules and regulations for example unbundling of outpatient surgery costs.

58
Q

What is the Criminal Health Care Fraud Statue

A

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

59
Q

Exclusion of the OIG

A

Mandatory and permissive

60
Q

Mandatory Exclusion consists of

A 
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

Federal Regulations & Governing Bodies (2 decks)

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