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ADA Titles ANSWERY ¥ Title I: Employment Title Il: Public Services Title IM: Public Accommodations Title IV: Telccommunications Title V: Miscellaneous Who does Title I: Employment apply to? ANSWER¥ ¥ -Applies to private employers with 15 or more employers Who does Title I: Employment protect? ANSWERYV ¥ Protects qualified individuals with disabilities What does Title I: employment protect for these people? ANSWERY V from discrimination related to: -recruitment, including position advertising application procedures -hiring and firing -training, advancement, and tenure -compensation and benefits Definition of Disability ANSWERV V -physical or mental impairment that substantially limits one or more major life activities -a record of such an impairment -being regarded as having an impairment Who meets the definition of disabled? ANS WERV V Person who has a condition that substantially limits major life activities like epilepsy, HIV/AIDS, substantial sensory impairment, or Icarning disability Who doesn't meet the definition of disabled? ANSWERY ¥ person who has condition that is minor, non-chronic or of short duration like the flu, sprains, or broken bones What is a major social life activity? ANS WERV ¥ -interaction with others -forming and maintaining relationships -communication What is a major cognitive life activity? ANSWERV ¥ -concentration -making decisions -complex thinking -abstract thinking -memory -attention -perception distinguishing real vs imaginary -entry -sidewalk What are things in Internal workplace accessibility? ANS WERV V -work station access -door and hall widths -floor surfaces and coverings -access to equipment/supplies, work space -rest rooms -ealing areas -elevator/escalator -fountains and vending What does Title II: Public Services cover? ANSWERV J Mandates accessibility of Federal Government, State Government, Local Government and includes public transportation -individuals with disabilitics cannot be excluded from services, programs and aclivitics -new facilities must be accessible -existing facilities must provide "program accessibility" What does Tile IH: Public Accommodations cover? ANSWERV ¥ mandates accessibility of business including: -lodging -food service entertainment and sports venues -shopping -museums, zoos, and parks -libraries -health care -education What makes a place publicly accessible? ANSWERV V -new construction or renovation projects must be accessible -existing facilities required to remove or modify structural barriers when "readily achievable" je? ANSWERY ¥ -ramps and slopes What can be changed to make services accessil -steps, elevators, escalators -doors and hallways -signs -flooring -obstacles and protrusions -reach range and clear space -seating -cquipment -paths and walkways -parking and loading -alarms and warnings -emergency refuge -lavatory counter minimum of 32in high, knee space of 29 in and pipes must be covered regulations/recommendations for kitchen design ANS WERW ¥ -space between cabinets and walls minimum of 48 in -variable height from 28in to 42in work surfaces Things to consider internally in home assessment? ANS WERV V -door width/thresholds -stairs -lighting -safety devices -HVAC -controls -windows -floor coverings Things to consider externally in home assessment? ANS WERV V -sidewalks and driveways -garage/carport -approach to entry -entry -access to grounds 3 points in the "3-leggcd stool” in health care reform ANSWERV ¥V Access, Costs, Quality What is health care reform of Obama administration called? ANSWERYV V Affordable Care Act of 2010 What are issues addressed in ACA 2010? ANSWERV ¥ -consumer protection -healtheare quality and costs access to care insurer accountability What does ACA 2010 do for consumer protection? ANSWERY V -insurers can't exclude children with preexisting conditions -illegal to rescind coverage for those diagnosed with serious illness -elimination of lifetime insurance coverage limits -regulate annual insurance coverage limits -standardize appeal process for insurer decisions What does ACA 2010 do for quality and costs? ANSWERYV V -gives tax credits for small businesses offering coverage -gives tax credits for seniors in the "donut hole" -mandatory coverage of preventive screenings -establish Public Health and Prevention Fund -Fighting fraud and abuse What does ACA 2010 do for access to care? ANSWERV ¥ -insurance coverage for adults with procxisting conditions -standardization of billing/electronic records -collection of data to identify and reduce disparities Characteristics of patient centered medical homes? ANSWERV ¥ -each patient has a personal physician (primary care) -physician directed team -whole person orientation -coordinated (or integrated) care -quality and safety -enhanced access -payment Characteristics of accountable care organizations? ANSWERV V -seek to integrate providers -payment would made to ACO, which would distribute payment to providers -ACO would be rewarded for saving money (targets set by Independent Payment Advisory Board) What changes have been made in 2012 to ACA in access to care? ANSWERV V -new, voluntary options for long term care insurance What changes will be made in 2013 to ACA in quality and costs? ANSWERV V -coverage of preventive services under medicaid -bundling of acute/post acute care What changes will be made in 2013 to ACA in access to care? ANSWERV ¥ -increase payments to PCPs -increase CHIP (Children Health Insurance Plance) funding What changes will be made in 2014 to ACA in consumer protection? ANSWERV ¥ - illegal for insurers to discriminate based on pre-existing conditions or gender -eliminate annual insurance coverage limits -illegal to drop insurance coverage to patients participating in clinical trials What changes will be made in 2014 to ACA in quality and costs? ANSWERV ¥ -tax credits for middle class without employer coverage -health insurance exchanges (no public plan option) -tax credits for small businesses who provide employee coverage (large company—50 employees or more) What changes will be made in 2014 to ACA in access to care? ANSWERV ¥ -expand medicaid coverage -individual mandate to have coverage -employer mandate to provide insurance coverage What changes will be made in 2015 to ACA in quality and costs? ANSWERV V -payment to providers based on quality Update on medicare therapy cap do? ANSWERY V -attempts to include repeal of the caps have been unsuccessful Pre industrial era medical education? ANS WER¥ V -was not science based -was taught that pt had "humors" on their body, not germs -were sickness clouds called "meazma" that went from town to town Physicians of the Pre Industrial cra? ANSWERV ¥ -were trained on an apprenticeship, usually about 8 months long and they would follow the country MD around and watch -No labs, libraries, or curricular standards -they were not valued -bleeding, emetics, and laxatives were primary forms of Tx -MD knowledge matched by laypersons, execeded by clergy (grandma's remedy was better) -Faced competition from barbers and tailors Hospitals of the Pre industrial era? ANSWERV Vv -they were rare and frightening -Almshouses and Pesthouses were forerunners of US hospitals -They were only in large cities -they were viewed as places of death and welfare, and not a beacon of healing Scientific advancements during industrial revolution? ANSWER V -brought reforms in medical education -Harvard linked medial education to the university and lengthened the curriculum which was outcome of the Flexner report (around 1915 to 1920) -Johns Hopkins created the first post-baccalaureate medical school program -Based on the Flexner report the AMA promoted today's system of medical education Medical profession during industrial revolution? ANSWERV V -Were being more like England -Scientific advances and changing population characteristics made MD services unique and relevant -State and county medical societies took control of MD licensure -AMA took control of the medical education Hospitals during industrial revolution? ANSWERV ¥ -Development and expansion of hospitals provided venues for cutting edge medical care -Provided central location for expensive technologies -Advancements in nursing practice and education paralleled development of the medical profession -Although not employees of hospitals, physicians held strong influence over hospital policies What was the first form of health insurance? ANSWER¥ V workers compensation When did health insurance start? ANSWERV V During industrial revolution Growth of Private insurance during industrial revolution? ANSWERV V -Following WWII employer sponsored health insurance became a common worker benefit -During WWII wages and other benefits were frozen -One of the big benefits was payment for health insurance -Changes in tax laws made health insurance a tax exempt benefit -Employer based coverage spread quickly to become the primary source of health insurance coverage in the US -Clinton proposal of 1994 failed despite widespread public dissatisfaction with the current healthcare system Market justice vs. Social Justice ANSWERV ¥ -US culture favors market justice over social justice -Middle class is resentful of taxation -Middle class is distrustful of "Big Government" -The AMA and others have used these characteristics to oppose attempts at national coverage plans Costs of coverage continue to rise? ANSWERV V -Expected to reach 20% of GDP in the next decade -Insurance premiums are rising faster than inflation -The number of uninsured (including employed) continues to rise -Patients have higher out of pocket costs and face more restrictions in their care What are cost control mechanisms? ANSWERV v -Adopted by government programs -Medicaid has shifted to managed care in many states, with little success -Medicare has adopted prospective payment in most settings (get flat rate for diagnosis is example) -Medicare continues to experiment with managed care -Medicare Part C makes it that pts can chose if the what traditional part A and B or do they want a managed care program (Medicare Advantage Plan) Shift to managed care? ANS WERY ¥ -Shifted to this from private insurance -Managed care involves integration of health care providers with payers -Managed care involves limiting pt choice -It involves limiting provider control -Involves cost sharing with the patients 
