Regulatory Systems

Question 1

Potential penalties

Answer 1

loss of the opportunity to treat covered clients, monetary fines, imprisonment, or the loss of a professional license or credentials to practice

Question 2

Oversight is what

Answer 2

the coordination of agencies, departments and offices that carefully watch the practices of health care organizations to protect the public, and ensure quality care and compliance with laws and regulations.

Watchful care
Delegation of enforcement of the regulations

Question 3

What is the principal federal government agency for protecting the health of all Americans?

Answer 3

US department of health and human services (HHS)

Question 4

HHS

Answer 4

US department of health and human services
largest departments in the federal government – encompasses Medicare, Medicaid, public health, medical research, child and family services…
Over 300 programs!

Question 5

ACF

Answer 5

Administration on children and families
economic and social well-being of families, children, individuals, communities. Focus on creating strong communities (domestic violence, head start…)

Question 6

AoA

Answer 6

Administration on Aging

coordinates and monitors home and community-based services for the older adult. (meals on wheals, adult day care)

Question 7

AoA includes what

Answer 7

National Center on Elder Abuse – prevent elder abuse

Senior Medicare Patrol (SMP) – trained to recognize and report health care fraud

Question 8

AHRQ

Answer 8

Agency for healthcare research and quality
improve the quality, safety, efficiency, and effectiveness of health care – One of 12 from HHS that supports research – focus on providing EBP info and clinical practice guidelines

Question 9

CDC

Answer 9

Centers for disease control and prevention
protect health through health promotion, air and food quality, prevention of disease, injury and disability, and preparedness for new health threats. Maintains data and stats on stuff like cancer, diabetes, obesity

Question 10

What is part of the CDC

Answer 10

NIOSH - national institute for occupational safety and health
- they provide recommendations

Question 11

FDA

Answer 11

Food and drug administration

responsible for protecting the public health

Question 12

What is part of FDA

Answer 12

MedWatch program – Providers report events with medical products to them

Question 13

HRSA

Answer 13

Health resources and services administration

primary agency to improving access to basic health care for those who are medically underserved.

Question 14

What is part of HRSA

Answer 14

Affordable care act falls under this administration

National Health Service Corps – loan or scholarship given to people who then practice in underserved areas

Question 15

HIS

Answer 15

Indian Health service
provides the primary health care services American Indians and Alaskan natives.
Provides hospitals, health care clinics & agencies. – services only for members of tribe

Question 16

NIH

Answer 16

National institute of health
nation’s medical research agency and makes important discoveries that improve health and research (majority of their budget goes to research too)

Question 17

CMS

Answer 17

Centers for medicare and medicaid

Administers medicare, medicaid, state childrens health insurance program (CHIP), health insurance marketplace

Question 18

MACs

Answer 18

Medicate administrative contractors

administer Medicare part A and B programs – review and process claims, decide what is covered under med program

Question 19

RAC

Answer 19

Recovery audit contractors
developed to identify and recover improper Medicare payments for both part A and B services. – review claims, look for billing abnormalities and identify over and under payments

Question 20

Which regulatory agency may file lawsuits in federal court to enforce ADA?

Answer 20

DOJ
DIA
OIG
OCR

Question 21

DOJ

Answer 21

Department of justice - health care fraud and abuse program

enforces laws and defends interests of the US

Question 22

Parts of the DOJ

Answer 22

Health Care Fraud and Abuse Program - a joint program under the direction of the Attorney General and Secretary of HHS.  
Disabilities Act (ADA). - civil rights law the prohibits discrimination among those 	with disabilities

Question 23

DIA

Answer 23

Department of inspections and appeals
protects the health and safety of Iowans. May be different agencies in other states. In Iowa they inspect, and license places like restaurants and health care facilities – they can randomly perform an inspection

Question 24

OIG

Answer 24

Office of Inspector General
oversees the integrity of Department of Health & Human Services (HHS) programs. Oversight of CMS, CDC, FDA, NAH… They have ability to exclude providers and organizations for participating in federally funded healthcare programs (like Medicare)

Question 25

OCR

Answer 25

Office for civil rights
follows up on federal civil rights laws and the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule – they work to protect rights of non-discrimination – can be civil and criminal penalties if non compliant

Question 26

DOL

Answer 26

Department of labor
the improvement of work conditions; advancing opportunities for profitable employment; and assuring work-related benefits and rights.

Question 27

DOL includes

Answer 27

Fair Labor Standards Act (FSLA) and (min wages, overtime pay)
Family and Medical Leave Act (FMLA). (unpaid job protected leave of 12 wks in a 12 month period)

Question 28

OSHA

Answer 28

Occupational Safety and Health Administration
safe/healthful working conditions – Get input by NIOSH – ex is that facilities follow the hazard communication standard and have the sheets available for all materials they handle

Question 29

OWCP

Answer 29

Office of workers compensation programs
provides wage replacement benefits, medical treatment, and vocational rehabilitation for certain workers who experience work-related injury or an occupational disease (black lung benefits is as example for coal miners)

Question 30

ODEP

Answer 30

Office of disability employment policy
leadership in developing and influencing disability employment-related policies/practices to increase employment of people with disabilities – this is who gave recommendations for ADA

Question 31

OLMS

Answer 31

Office of labor management standards

an office under the USDOL, provides and monitors standards for labor unions.

Question 32

NLRB

Answer 32

National labor and relations board
an independent federal agency that protects private sector employees to join together to improve wages/ working conditions. Quasi judicial group that will hear and settle unfair labor practices, works to solve unions

Question 33

NLRB - right to work

Answer 33

There are “right to work” laws in 26 states so it is up to each employee to decide if they want to join a union and pay fees – IOWA is a right to work state – so you have a choice to join a union or not

Question 34

EPA

Answer 34

Environmental protection agency

develops regulations to reduce waste, the management of infectious waste, and safe disposal of sharps.

Question 35

State licensure boards

Answer 35

Each State has Licensure Boards or Agency that oversees regulations of PT/PTAs. Issuing and renewing licenses, follow up on complaints, establish rules – if PT changes address or name, they have 30 days to report it to the board before being put on inactive status

Question 36

NOn-governmental oversight voluntary accreditation

Answer 36

CARF
TJC (JCAHO)
CAPTE

Question 37

Determine most accurate/updated source -

Answer 37

Usually the official website will have the most up to date info
Ongoing education required because is constantly changing