Federal Healthcare Regulatory Requirements Flashcards
The purpose of this Act, or Federal “anti-dumping” law, is to fight hospitals transferring, discharging, or refusing to treat indigent patients coming to the emergency department because of cost factors. The Act protects anyone coming to a hospital seeking emergency medical services and imposes strict penalties including fines and exclusion from the Medicare program for violations of the Act
a. Patient Self-Determination Act
b. Emergency Transfer and Active Labor Act (EMTALA)
c. Healthcare Quality Improvement Act of 1986
Emergency Transfer and Active Labor Act (EMTALA)
This legislation requires the United States Department of Health and Human Services (DHHS) to develop standards and requirements for maintenance and transmission of health information that identifies individual patients. These regulations are divided into four Standards or Rules: (1) Privacy, (2) Security, (3) Identifiers, and (4) Transactions and Code Sets
a. Health Insurance Portability and Accountability Act of 1996 (HIPAA)
b. Patient Self-Determination Act
c. Healthcare Quality Improvement Act of 1986
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
This act requires that patients be allowed to participate in treatment decisions including the use of advance directives. Advanced directives are documents that allow a person to give directions about future medical care or to designate another person(s) to make medical decisions if the individual loses decision making capacity. Advance directives include living wills, durable powers of attorney for healthcare decisions, do-not-resuscitate (DNRs) orders, right to die, or similar documents expressing the individual’s preferences
a. Patient Self-Determination Act
b. Sherman Anti-trust Act
c. Emergency Transfer and Active Labor Act (EMTALA)
Patient Self-Determination Act
This Act provides: “Every contract, combination in the form of trust or otherwise, or conspiracy, in restraint of trade or commerce among the several States, or with foreign nations, is declared to be illegal”. The Act also provides: “Every person who shall monopolize, or attempt to monopolize, or combine or conspire with any other person or persons, to monopolize any part of the trade or commerce among the several States, or with foreign nations, shall be deemed guilty of a felony.” Hospitals must take precaution not to violate this Act when making medical staff appointment or privileging decisions, when making referrals to physicians or other health care practitioners, and when contemplating joint rate setting with other healthcare organizations
a. Healthcare Quality Improvement Act of 1986
b. Sherman Anti-trust Act
c. The Patient Safety and Quality Improvement Act of 2005 (PSQIA)
Sherman Anti-trust Act
The purpose of this Act is to encourage good faith professional review activities. It includes provisions for expectation to protect hospitals and medical staff members participating on peer review committees from potential liability in the form of money damages due to legal action taken after the revocation of a physician’s hospital privileges. In addition, the Act includes standards for conducting professional review actions (hearings). It also created the National Practitioner Data Bank (NPDB) and specifies the querying and reporting requirements for the NPDB
a. The Patient Safety and Quality Improvement Act of 2005 (PSQIA)
b. Stark Law
c. Healthcare Quality Improvement Act of 1986
Healthcare Quality Improvement Act of 1986
This law prohibits a physician who has a financial relationship with an entity from referring Medicare or Medicaid patients to that entity for the provision of a designated health service. There are eleven categories of designated health services including but not limited to inpatient hospital services, home care, etc. Violation of physician recruiting laws and regulations can lead to serious penalties, including loss of a hospital’s tax-exempt status and exclusion from Medicare and Medicaid
a. Stark Law
b. Americans with Disabilities Act (ADA)
c. Healthcare Quality Improvement Act of 1986
Stark Law
This law was enacted to “enforce the constitutional right to vote, to confer jurisdiction upon the district courts of the United States to provide injunctive relief against discrimination in public accommodations, to authorize the attorney General to institute suits to protect constitutional rights in public facilities and public education, to extend the Commission on Civil Rights, to prevent discrimination in federally assisted programs, to establish a Commission on Equal Employment Opportunity, and for other purposes.” It applies to discrimination in the medical staff application process
a. The Civil Rights Act of 1964
b. Americans with Disabilities Act (ADA)
c. Patient Protection and Affordable Care Act
The Civil Rights Act of 1964
This Act is a federal civil rights law that prohibits discrimination based on disability and bars discrimination against a qualified individual due to the disability. State and local court opinions vary regarding whether ADA applies only to employees only or includes medical staff members. It is up to individual hospitals to determine how the ADA applies to its privileging and credentialing processes. If the organization employs the medical staff member, the ADA applies
a. Stark Law
b. Americans with Disabilities Act (ADA)
c. The Patient Safety and Quality Improvement Act of 2005 (PSQIA)
Americans with Disabilities Act (ADA)
Final Rule, 42 C.F.R. Part 3, was published on November 21, 2008, and is effective on January 19, 2009. This Act establishes a voluntary reporting system designed to enhance the data available to assess and resolve patient safety and health care quality issues. To encourage the reporting and analysis of medical errors within health care systems, This Act provides Federal privilege and confidentiality protections for patient safety work product. Patient safety work product includes patient, provider and reporter identifying information that is collected, created or used for patient safety activities. Civil money penalties (CMPs) may be imposed for knowing or reckless impermissible disclosures of patient safety work product
a. Patient Protection and Affordable Care Act
b. Healthcare Quality Improvement Act of 1986
c. The Patient Safety and Quality Improvement Act of 2005 (PSQIA)
The Patient Safety and Quality Improvement Act of 2005 (PSQIA)
The law puts in place comprehensive health insurance reforms. The act created a provision for Accountable Care Organizations (ACOs). An ACO refers to a group of providers and suppliers of services (e.g., hospitals, physicians, and others involved in patient care) that will work together to coordinate care for the patients they serve with Original Medicare (that is, those who are not in a
Medicare Advantage private plan). The goal of an ACO is to deliver seamless, high quality care for Medicare beneficiaries. The ACO would be a patient centered organization where the patient and providers are true partners in care decisions. ACOs create incentives for health care providers to work together to treat an individual patient across care settings – including doctor’s offices, hospitals, and long-term care facilities. The Medicare Shared Savings Program will reward ACOs that lower growth in health care costs while meeting performance standards on quality of care and putting patients first. Patient and provider participation in an ACO is purely voluntary
a. Patient Protection and Affordable Care Act
b. Americans with Disabilities Act (ADA)
c. Patient Self-Determination Act
Patient Protection and Affordable Care Act
