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HMGT 3310 Organizations (1-4) and HMGT 3310
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1.HMGT 3310 Organizations (1-4) 2.HMGT 3310 Midterm F HMGT 3310 Organizations (1-4) Department of Health and Human Services (DHHS) - ANSWER Implements most of thefederal healthcare regulatory infrastructure through component agencies
Centers for Medicare and Medicaid (CMS) - ANSWER Administers the Medicare programand the federal portion of the Medicaid program and State Children's Health Insurance Program Health Resources and Services Administration (HRSA) - Answer Provides fundingprograms for health care training, the National Practitioner Data Bank for physician disciplinary actions, and coordinates the organ donation network UNOS Indian Health Service (IHS) - Answer Provides hospitals and other health care servicesfor Native Americans
Office for Civil Rights (DHHS) - Answer Enforces privacy provisions of the HealthInsurance Portability and Accountability Act of 1996 (HIPAA) and civil rights protections
Department of Defense (DOD) - Answer Operates hospitals and provides other healthcare services for active-duty military personnel, their dependents, and retirees
Department of Labor (DOL) - Answer Administers Employee Retirement Income SecurityAct of 1974, which applies to employee health benefits arrangements
Veterans Administration (VA) Answer Operate hospitals and other health care servicesfor veterans, conduct and fund research on health services
Departments of health Answer Investigate public health threats, house licensure boardsin some states, administer health planning and certificate-of-need programs in some states, regulate clinical operations of managed care organizations Boards of medicine Answer License and discipline physicians Boards other health professions Answer License and discipline allied healthprofessionals
Departments of welfare Answer Administer Medicaid programs in many states Departments of insurance Answer Regulate the sale and underwriting of private healthinsurance, including managed care arrangements, except when preempted by ERISA
Accreditation Council on Graduate Medical Education Answer Accredits medicalresidency programs
American Board of Medical Specialties ABMS Answer Coordinates activities of medicalspecialty societies
Association of Schools of Allied Health Professions (ASAHP) - Answer Coordinates theaccreditation of training programs for allied professionals
Educational Commission for Foreign Medical Graduates (ECFMG) - Answer Certifiesgraduates of foreign medical schools to enter ACGME-accredited medical residencies and fellowships
Medicare and Medicaid 1965 - Provided medical insurance for over 65s and hospitalcare for the poor
EMTALA - Prevented the hospitals from transferring the uninsured or Medicaid patientsto the public hospitals without a medical screening examination and stabilizing treatment Affordable Care Act - Law passed in 2010 to expand access to insurance marketplace,expanded medicaid coverage, increased care
Patient's Bill of Rights - Answer - Insurance cannot deny for pre-existing healthconditions
- no lifetime/annual limits
- parents insurance coverage till 26- right to appeal denied claims
Federal government regulation - Answer - FDA-drugs, food, medical devices- CMS-Medicare, Medicaid, marketplace
- DHHS-CDC, NIH, HIPAA
- Others: FTC, DEA-controlled substances State government regulation - Answer - Licensing providers and facilities- sanitation standards, vaccines
- standards of practice and quality of care Physician Licensing - Answer - issued/renewed by state medical boards
- med school and national licensing exam Physician Credentialing - Answer - formal process of verifying qualifications and history
- background check (NPDB)
- performed by hospitals, health systems and orgs physician privilaging - Answer - specific rights in a healthcare org/facility
- performed by medical staff and governing body of a hospital National Practioner Data Bank - Answer A repository of information about health carepractitioner, established by the Health Care Quality Improvement Act
- reports malpractice, adverse actions
- promotes accountability Physician Oversight - Answer - state medical boards (licensing, disciplining,rulemaking)
- hospitals (credentialing/privileging, peer review, investigations)- professional societies (AMA)
- agencies (CMS, OIG) Medicare (CoP) - Answer CMS, branch of federal Dept HHS, responsible for creating andenforcing rules for hospitals, related to Medicare participation, content and documentation requirements, standards Certification of Need - Answer state level control mechanism, cost and duplicationcontrol
Medicare coverage - Answer > age 65, end-stage renal disease, ALS Medicaid coverage - Answer - children, pregnant women, disabled
- no medicaid for childless adults
- Technology (measuring outcomes)
- Policies (ACA) Legislative Branch (Congress) - Answer passes laws and sets budget for funding Executive Branch (President) - Answer carries out orders related to healthcare policies Judicial Branch (Supreme Court) - Answer enforces constitutionality of healthcare laws
