Heatlhcare policies - Chap 13

Hill Burton Act

constructed 9200 hospitals to increase supply of hospitall beds so as to keep up with demand, particularly in smaller communites and rural areas

community mental health act

provided $ for the creation of community mental health centers. treatment of mental ill, metal retardation, and substance in the community rather than hospitalization, a new era of mental health treatment

social security act (medicare/medicaid)

medicaid is redistributive

medicare & SSA are distributive

anti-kick back statute

prohibits heatlhcare providers from making a referral that results in a kickback ($ or anything of value) for said referral

HMO act

passed to slow the escalating HC costs by providing an alternate to traditional fee-for-services health insurance plans

national health planning & resources development act

marked the transition from access to care to cost containment through the establishment of certificate of need (CON) laws and introduction of prospective payment system (PPS) for medicare

community support program (CSP)

established by National Institute of mental health; $ provided for communities to set-up comprehensive mental health services and supports (such as housing, case mgmt) to help mentally ill patients become integrated successfully into society

COBRA

provides workers and their families who lose their heatlh benefits the right to choose to continue their group health insurance for limited periods of time under certain circumstances (voluntary or involuntary job loss, reduction in hours worked, transition btwn jobs, death, divorce, and other life events) 

qualified individuals may be required to pay the entire premium for coverage up to 102% of the cost of the plan

healthcare quality act

created national database to track legal actions against healthcare providers

EMTALA

the emergency medical treatment and labor act requiresanyone coming to an ER to be stabilized and treated, regardless of their insurance status or ability to pay

STARK 1

prohibited MDs from referring medicare patients to labs in which they or a family member held a financial interest

OBRA

created agency for HC research and quality to conduct and support research related to patient outcomes, effectivness and appropriatness of HC services being rpovided, created “standards of care”

ADA

protections for individuals with physical disabilities and mental illness from discrimination hiring/firing violations, ensures equal access to building and services

Stark II

same as stark I plus: NO referrals of medicare patients to any designated healthfacility (so more than just labratories) where the physician or their family holds a financial intrest; some safe harbors esist

HIPPA

helsp to protect privacy of patient information; gives certain rights over the use of their medical information and limitations on who. may access information

mental health parity act

prohibited health plans from imposing stricter annual or lifetime spending limits on mental heatlh benefits than the limits on medical and surgical benefits

S-CHIP

provided flexibility in how states spend federal $ for children’s health insurance coverage: Alabama’s plan is called ALL kids

BBA

gave states authority to implement mandatory enrollments into managed care plans (MCO) for medicaid recipients, created CAH (critial access hospitals) to prevent rural hospital closures; created CHIP to cover ¼ of children in low-income families health insurance; intent of legislation: reduce $160B of spending reductions between 1998 and 2002 actually saved $127B

medicare C and D

c: medicare advantage 

d: Rx coverage/drugs

healthcare savings accounts

allows you to set aside money on a pre-tx basis to pay for qualified medical expenses, by using untaxed dollars in a HSA to pay for deductibles, copayments, coinsurance, ect, you may be able to lower your overall HC costs

mental heatlh parity and addiction equity act

prevents group health plans from imposing less than favorable limitations on coverage benefits than what is covered for other medical/surgical benefits

ADAAA

broadened the definition of “disability” thus increasing # of people covered by ADA

ACA

goal is to reduce the # of uninsured americans through affordable health plans on the healthcare exchange and medicaid expansion