Policy and Legislation

Question 1

payment systems that influence practice developed as a result of public policy

Answer 1

• Medicare
• Medicaid
• Social Security

Question 2

role of COTA with regards to payment policy regulations

Answer 2

• COTAs should understand and follow specific guidelines to receive payment
• OTRs signature
• services must be skilled

Question 3

PDPM meaning/ what is it

Answer 3

patient driven practice model
- reduce administrative burdens for health providers by focusing on each patient’s unique needs
- SNF

Question 4

PDGM meaning/ what is it

Answer 4

patient driven group model
- relies more heavily on clinical characteristics, and other patient information to place home health periods of care into meaningful payment categories
- home health

Question 5

importance of advocacy in OT profession

Answer 5

OTs must always be adjusting to change and adapting to new ways to deliver intervention because of the change and progressiveness of the field

Question 6

managed care

Answer 6

a healthcare insurance approach that integrates the financing of health care and the delivery of care and related services to keep the costs to the purchaser at a minimum while delivering what is appropriate for a given patient or population of patients
- quality of care high and quantity of pay low

Question 7

Medicare

Answer 7

• 65+
• entitled to disability benefits for at least 24 months
• end-stage renal disease
• who buy into the program

Question 8

Medicaid

Answer 8

a joint federal and state program that gives health coverage to some people with limited income and resources

Question 9

OBRA of 1987

Answer 9

creates a set of national minimum set of standards of care and rights for people living in certified nursing facilities
- more client-focused

Question 10

skilled vs. unskilled services

Answer 10

skilled: involve the therapist directly
- teaching adaptive skills
- assisting patients with safety
unskilled: involve the therapist indirectly
- positioning
- heat as comfort
- routine assistance in dressing, eating, or toileting

Question 11

AARP meaning/ what is it

Answer 11

the american association of retired persons
- senior discounts and offers

Question 12

quadruple aim

Answer 12

• improve the health experience
• improve the health of populations
• reduce the cost of healthcare
• preduce practitioner burnout

Question 13

minimum data set

Answer 13

• a standardized, comprehensive assessment of an adult’s functional, medical, psychosocial, and cognitive status
• used to determine Medicare payment for eligible residents
• even if no intervention has taken place, information from the MDS can be used to tell other members of the IDT