EXAM 1 - part 1
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97 Terms
laws, regulations, policies
purpose is to protect the public, ensure competence of providers, and make sure tax dollars are spend wisely
laws, regulations, policies
differ from state to state and program to program
federal law
when there is a conflict between state and federal law, who prevails?
No
Does denial of reimbursment make services illegal?
Laws
Rules of action/ conduct prescribed by the controlling authority that have binding legal force
Laws
Purpose is to protect citizens from unsafe practices
both
Do laws address offenses against society or by one person to another or both?
Constitutional law, Statutory law, Common law, Administrative law
4 sources of law in the U.S.
U.S constitution, Bill of Rights
2 documents that make up constitutional law
constitutional law
takes precedence over all other laws and regulations
federal statutes
Supercedes state law
Statutes
a type of law that is “enacted and established by the will of the legislative department of government”
statutory law
enacted by congress or state legislatures
congress
is a federal body
statutory law
enforced by state and federal court systems
federal statutes
examples include Americans with Disabilities Act and Social Security Act
true
true or false: states can make their own laws as long as no federal law exists
criminal law
Infractions against society
the public
in criminal law, State prosecutes in a court of law on behalf of who?
criminal law
May involve fines, probation, and/or imprisonment
Criminal prosecution
will not directly affect the provider’s license, but may result in referral to state professional disciplinary agency
criminal law
Usually state and federal statutes, rather than common law
federal statutes
address areas that federal government is constitutionally permitted to regulate
state statutes
address areas that states are constitutionally permitted to regulate
federal statutes
Apply to all citizens across state lines
state statutes
vary from state to state
state statutes
state physical therapy practice acts would fall under what?
model practice act
Developed by Federation of StateBoards of Physical Therapy
state physical therapy practice acts
Which makes laws: state physical therapy practice acts or the APTA?
model practice act
Serves as a guide to assist in the modification of state practice acts
state physical therapy practice acts
Identifies licensure and supervisory requirements
model practice act
Purpose is for consistent physical therapy regulation
model practice act
Not a statute and does not have the force of a law
false
true or false: not all states have some form of direct access
Licensure
Creates a scope of practice, authorizes the person to practice in a given state
licensure and certification
both legally protect a professional title
ilcense individuals
who is allowed to use the title of PTA?
certification
Does not create a scope of practice or a monopoly to provide a particular service
registration
Licensed and certified providers are required to participate in this
state regulatory agencies
erve to administer licensing procedures
registration
practitioners periodically provide updated information, qualifications, and pay for this
State of Alabama Board of Physical Therapy Practice Act, and State of Alabama Board of Physical Therapy Administrative Code
2 sources review the laws and regulations for maintain registration in Alabama
private certifications
private corporations (ex: APTA) certify practitioners as specialists in a particular area
No
Can private certifications create legally enforceable professional titles?
common law
Based on judicial decisions that create legal precedent in areas not covered by previous statutes
state regulatory agencies
Cannot change the practice acts adopted by the state legislatures
common law
created by court decisions, written by judges, and handed down;
previous court cases
what provides basis for common laws?
common law
what is negligence primarily governed by?
civil law
Concerned with private wrongs and remedies, usually common law
PT
who would be held liable even if they did not render the services: the PT or PTA?
civil law
One private citizen brings a lawsuit against another to seek compensation for injuries
malpractice
failure to listen to patients’ complaints of pain
civil law
Cannot affect a professional’s license, but may result in a complaint to the state board
malpractice
Dropping patients during an exercise
civil law
employment contracts, independent provider contracts, tuition reimbursement contract, and therapy reimbursement contracts all fall under:
risk management
Coordinated effort by an organization to “identify, assess, and minimize, where possible, the risk of suffering harm or loss to patients, visitors, staff and the organization.”
malpractice
failure to modify a physical therapy plan for weak patients
negligence
failing to mop up water or put down a wet floor sign causes someone to slip and get hurt.
civil law
defamation, breach of contract, negligence, or malpractice would all fall under what law?
malpractice
leaving patients unsupervised during exercises
change in pt. status, emergencies, identified problems
PTs and PTAs must respond appropriately to all of the following: (3)
malpractice
Failure to inform patients about the risks of physical therapy
negligence
DOING something a reasonably prudent person would NOT have done in similar circumstances
malpractice
Failing to repair equipment in a therapy center
PT
who should advise the patient of the credentials of the person rendering service: PT or PTA?
malpractice
excessive mobilization to a joint causes an injury
timely, accurate
PTs and PTAs must provide documentation that is ____ and ____.
negligence
failing to act as a reasonably prudent person
malpractice
Sexual assault
negligence
failing to do something a reasonably prudent person would have done under similar circumstances
malpractice
professional negligence
state regulatory agencies
Serve to prosecute professional misconduct cases
malpractice
failure to do what a reasonably prudent member of the profession would have done
PT
who has ultimate responsibility over pt. care: the PT or PTA?
employer
may be held liable even though they did not provide services due to the fact that they can control the quality of care rendered by controlling the work place
contracts
an agreement between two or more persons which creates mutual obligations to do or not to do something”
civil law
contracts can be enforced in court. What category of law do they fall under?
breach of contract
Not fulfilling the terms of the contract
employment contracts
breach of contract: employer may be entitled to monetary damages as stated in the contract
tuition reimbursement contracts
breach of contract: the employer may be entitled to all or a percentage of the reimbursement provided as stated in the contract
therapy reimbursement contracts
breach of contract: the payer may deny reimbursement or drop the provider
administrative law
are also known as regulations
administrative agencies
have authority to develop regulations and enforce them within a specific industry or program
regulations
often relates to service delivery and reimbursement in health care
administrative law
established and enforced by administrative agencies as authorized by executive and legislative branches of government
regulations
purpose is to ensure a fair distribution of goods and services
governmental agency
who are regulations made by: governmental agency or legislature?
regulations
Rules controlling the practices of individuals or organizations under the authority of agencies
agencies
created by federal and state statutes to regulate a particular industry or program
Centers for Medicare & Medicaid Services (CMS)
who regulates medicare and medicaid?
Department of Health and Human Services
What is the Centers for Medicare & Medicaid Services (CMS) apart of?
Centers for Medicare & Medicaid Services (CMS)
establishes regulations for the Medicare and Medicaid system
regulatons
set by CMS and must be followed for reimbursement
state regulatory agencies
serve to provide advice to state-licensed practitioners with questions concerning practice issues
Fraud
committed if billing is not done according to regulations
state regulatory agencies
Serve to advise the legislature