Online mha Resources

8 Important Regulations in United States Health Care

Image of an old fashioned, double bowl scale in a legal setting

With Congressional oversight, United States health agencies develop laws designed to protect public well-being. The Department of Health and Human Services (HHS) oversees the general health issues and concerns of all American citizens, spearheading initiatives that improve public health and further medical research. In 2016, the mission of the HHS entailed improving patient outcomes and reducing medical costs. Throughout time, the HHS has worked toward such goals by supporting various new laws. As a result, the following eight acts of legislation have had a significant impact on health in America.

Healthcare Quality Improvement Act of 1986 (HCQIA)

The Healthcare Quality Improvement Act (HCQIA) provides immunity for medical professionals and institutions during conduct assessments. [1] The law originated partially due to a Supreme Court ruling involving abuse of the physician peer review process. To date, HCQIA continues to evolve as the act arises in courtrooms and justices deliver new rulings. Legislators enacted the law to protect medical professionals from peer review-related lawsuits and to encourage physicians to file official complaints after encountering unprofessional and dangerous peer conduct.

Medicare

The Medicare program provides insurance coverage for almost 50-million American citizens. [2] In 1945, President Harry Truman rallied Congress for funding to insure all United States citizens. Twenty years later, president John F. Kennedy finally succeeded in providing coverage for U.S. senior citizens. Today, the Congressional Budget Office forecasts that the program will survive indefinitely thanks to sweeping spending reforms.

Medicaid

President Johnson’s 1965 legislation also included a provision to provide insurance for low-income individuals. [3] Today, Medicaid provides coverage for over 70-million American citizens. In 2014, the program reimbursed hospitals for almost 50-percent of all medical expenses.

Medicaid covers various recipients, such as uninsured expectant mothers, temporarily unemployed workers and disabled individuals. Recently, new legislation has lowered the nation’s uninsured rate to under 9-percent, representing the highest coverage rate in U.S. history.

Children’s Health Insurance Program (CHIP)

Along with the Medicaid, the Children’s Health Insurance Program (CHIP) has created a strong foundation for delivering health coverage to children living in low-income households. The program originated with the Children’s Health Insurance Authorization Act of 2009 (CHIPRA) and has successfully provided services to many previously disqualified clients. The program has an extensive history of providing insurance to underprivileged children and receives funding from respective states and the federal government. Today, the Affordable Care Act (ACA) makes this service accessible to the largest number of low-income children in the country’s history.

Hospital Readmissions Reduction Program (HRRP)

The Hospital Readmissions Reduction Program (HRRP), an Affordable Care Act initiative, requires the Centers for Medicare and Medicaid Services (CMS) to reduce payouts to care facilities that experience excessive patient readmissions. [4] The program launched in late 2012 and defines readmissions as ‘repeat patient admissions among participating CMS hospitals in a 30-day period; allowing exceptions for specific conditions, such as heart failure and pneumonia, as well as factors such as poor health and multiple illnesses.’

Health Insurance Portability and Accountability Act (HIPAA) of 1996

The Health Insurance Portability and Accountability Act (HIPAA) protects America workers by allowing them to carry health insurance policies from job to job. [5] The program also permits workers to apply to a select group of health insurance plans to replace lost coverage and adjust for family changes such as marriages, births and adoptions.

HIPAA bars insurers from discriminating against policy applicants due to health problems. In some instances, if an insurance company denies a worker’s application, the individual may apply for coverage outside of the normal enrollment period. Additionally, the act preserves state laws that protect workers’ insurance rights.

Patient Safety and Quality Improvement Act (PSQIA) of 2005

The Patient Safety and Quality Improvement Act (PSQIA) protects health care workers who report unsafe conditions. [6] Legislators created the law to encourage the reporting of medical errors, while maintaining patients’ confidentially rights. To ensure patient privacy, the HHS levies fines for confidentially breaches. The law also authorizes the Agency for Healthcare Research and Quality (AHRQ) to publish a list of patient safety organizations (PSOs) that record and analyze patient safety data. The Office for Civil Rights (OCR) enforces the law among national health care facilities.

Affordable Care Act of 2010

In March 2010, president Barak Obama sanctioned the Affordable Care Act (ACA), a somewhat modified version of the all-inclusive coverage imagined by presidents since the early 1900s. [7] The act requires most U.S. citizens to apply for health insurance coverage, levying a penalty for individuals who fail to secure insurance but making exceptions for a few protected groups. Under the law, enterprises that employ more than 200 workers must provide health insurance coverage. The act also established the American Health Benefits Exchange, where citizens can review and compare insurance plans.

The Affordable Care Act offers health care professionals the opportunity to participate in shaping the delivery of patient services. The medical field can benefit from input that helps deliver better services to the growing patient population while reducing care expenses. As a current or future decision maker in the health care field, care providers must reflect on how to create these results at their respective workplaces.

Learn More

At Regis, we give you more pathways to pursue your goals in healthcare administration. As a dedicated leader of health administration education, we welcome ambition-driven, self-motivated professionals like you from all health care settings. Gain special insight into areas like management, communications, health informatics, and health policy through our Online Master of Health Administration program.

Sources

[1] Western Michigan University
[2] Medicare Resources
[3] Medicaid & CHIP
[4] Centers for Medicare & Medicaid Services
[5] Department of Labor
[6] Health & Human Services
[7] The Henry J. Kaiser Family Foundation