law- practice questions OBRA & HIPAA for final exam Flashcards
OBRA ‘90 was the first law to do what
what is the primary goal?
what model did it adopt?
what does it require states to do? in order for the state to get what
first federal law directly regulating pharmacy practice standards
The primary goal to save money
Adopts the “pharmaceutical care” or “pharmacist care” model that pharmacy developed for itself
The law establishes minimal requirements that states must adopt and requires that states actually establish the standards in order to continue receiving federal funds for Medicaid.
who are rebates for and what is the requirement
what is the ____ price?
how is a rebate accomplished?
for manufacturers
for them to provide drug products to the Medicaid program at their best price
the best price is the lowest price of the product
accomplished by the manufacturer showing the difference between the average manufacturer’s price and the best price
who funded demonstration projects?
what does it evaluate
OBRA funded demonstration projects
used to evaluate whether the DUR requirements would result in improved patient care and decreased costs.
what does DUR stand for
what are the types of DUR programs?
Drug use review
two types:
– retrospective review
– prospective DUR (Pro-DUR)
what must each state have concerning a DUR board?
what does the DUR board do
what does the board have the authority to do
which type of DUR is this under
Each state must establish a DUR board composed of physicians and pharmacists to oversee retro-DUR.
The board reviews medication use data and compares it to target criteria.
The board has the authority to recommend and establish educational programs for providers who are not meeting target criteria.
this is retrospective DUR
what does prospective DUR evaluate
what does it examine
evaluates the prescribed drug therapy before the Rx is dispensed
The DUR board can examine data generated from pro-DUR to determine if drug use problems are being resolved or continuing.
what are the components of Pro-DUR?
screening
counseling
patient profile
for screening under Pro-DUR
what must a pharmacist do
what does OBRA have
can the computer software replace a pharmacist
Pharmacists must detect potential drug use problems before Rx is dispensed.
OBRA lists seven general categories of potential problems that should be screened.
Computer software does not replace the professional judgment of a pharmacist.
for counseling under pro-dur
what does it require
what does it provide to the pharmacist?
what does common severe side effect believed to mean
who can offer to counsel
what does the patent have the right to do
Requires an “offer to counsel” patient or caregiver
Lists several points of information counseling could include, but allows pharmacist to determine the content of the counseling based on professional judgment
Meaning of phrase “common severe side effect” generally believed to mean common or severe
An offer to counsel may be made by ancillary personnel or other means in some states, while some states require counseling, the patient has the right to waive counseling.
for patient profiles under pro-dur
what does it require the pharmacy to have
what must be reviewed before dispensing and what is it critical for
Requires pharmacy to obtain, record, and maintain a record of specified information about the patient
A review of the patient profile prior to dispensing is critical to effective screening and counseling.
what does HIPAA stand for
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
what is the general purpose of HIPAA
what is the partciular purpose of HIPAA
who enforces HIPAA
to improve the efficiency and effectiveness of the healthcare system
Particular purpose to regulate the privacy and security of health information
Enforced by the Department of Health and Human Services
what does HIPAA target
Transaction and code sets
National provider identities
Security of health information
Privacy of health information
what is Transaction and code sets
and what is it under
under HIPAA
Intent to establish uniform standards for electronic claims and data transmission to improve efficiency and lower costs
what is National provider identities
and what is it under
under HIPAA
Intent of uniformity, simplicity, reduced cost
what are the security requirements of HIPAA?
can entities develop their own HIPAA standards
Requires covered entities to develop physical, technical, and organizational procedure safeguards in order to protect health information from being improperly accessed, altered, deleted, or transmitted
Entities have considerable latitude to develop their own security measures, provided they achieve HIPAA objectives and standards.
what is privacy requirements concerned with
what is the remainder of the HIPAA conversation concerned with
Concerned with patient’s rights and how and when the patient’s information may be used
Most of the remainder of the HIPAA discussion is concerned with privacy requirements
who must comply with HIPAA?
what can the people who must comply to exempt
Covered entities (including health plans and healthcare providers that conduct transactions electronically) Business associates of covered entities
A covered entity may exempt non-healthcare parts of its operation.
what is PHI
Protected Health Information (PHI)
What does PHI include
Includes electronic and hard copy health information that both:
- Relates to past, present, or future physical or mental health, provision of care, or payment for care
- Could identify the patient
what must a pharmacy provide and what must it contain
where must the two places that the requirement must be posted
Pharmacy must provide a “Notice of Privacy Practices” containing certain required information.
The notice must be posted in a prominent and visible location and made available upon request to any person.
If a pharmacy has a website, the notice must be posted there.
what must a pharmacy make a good faith effort to do
how many times is it required for a patient
what a pharmacy not refuse even if the patient _____
can it ever be extended
who can sign this document
A pharmacy must make a good-faith effort to distribute notice to patients and obtain a written, signed acknowledgment of receipt.
Only required once for each patient
Cannot refuse treatment if patient refuses to sign
A written acknowledgment may be extended in several ways.
An acknowledgment may be signed by a patient’s personal representative (PR), but not by an agent who is not a PR.
when is PHI used and disclosed
May be provided for the purposes of treatment, payment, and operations (TPO)
Must be provided to the patient if the patient requests
May be provided to the patient’s PR
May be provided to patient’s agent provided professional judgment applied
30-day requirement
when does a patient have the right to request and receive a report of disclosures
what does a yet to be finalized rule entail
when can a patiennt request for a PHI to not be disclosed
A patient has a right to request and receive a report of disclosures over the past 6 years, except for TPO.
A yet to be finalized rule would allow a patient to request and receive all disclosures over the past 3 years.
A patient can request PHI not be disclosed to health plan if the purpose is for payment or operations, or if patient paid in cash.
how much of a PHI can a pharmacy disclose
what still exists
A pharmacy may only disclose the minimum amount of PHI necessary to accomplish the objective.
Several important exceptions exist.
minimum necessary meaning
the exclusion of direct patient identifiers.
If complying with a limited data set is not possible, a pharmacy may include who
include direct identifiers to the minimum amount necessary and must be prepared to justify the use.
what are pharmacies not responsible for
Pharmacies are not responsible for incidental uses and disclosures of PHI, provided they applied “reasonable safeguards” to protect the PHI.
what is not PHI
How many items are considered to be identifiable
De-identified information is not PHI.
Eighteen items are considered as identifiable.
what must pharmacy students consider
where can a student not discuss what
what must be secured
De-identify all presentations involving patients unless specific patient authorization given.
Do not discuss patients in public areas.
Secure patient charts, computers, and electronic files containing identifiers.
