Unit 2: Health Care Laws and Regulations
Expert-defined terms from the Professional Certificate in Regulatory Compliance in Health Care course at London School of Business and Administration. Free to read, free to share, paired with a globally recognised certification pathway.
**Accreditation** #
**Accreditation**
Accreditation is the process by which a healthcare organization is evaluated and… #
In the United States, accreditation is typically granted by organizations such as The Joint Commission, the Commission on Accreditation of Rehabilitation Facilities (CARF), and the Council on Accreditation (COA). Accreditation helps ensure that healthcare organizations provide high-quality care and services, and it is often required for participation in federal and state healthcare programs.
**Advance Directive** #
**Advance Directive**
An advance directive is a legal document that outlines a person's wishes for med… #
There are two main types of advance directives: living wills and health care powers of attorney. A living will specifies the types of medical treatments that a person wants or does not want, while a health care power of attorney designates someone else to make medical decisions on their behalf.
**Affordable Care Act (ACA)** #
**Affordable Care Act (ACA)**
The Affordable Care Act (ACA), also known as Obamacare, is a comprehensive healt… #
The ACA aims to increase access to affordable healthcare coverage, improve the quality of care, and reduce healthcare costs. The law includes provisions such as the individual mandate, which requires most Americans to have health insurance or pay a penalty, and the creation of health insurance marketplaces where individuals and small businesses can purchase coverage.
**Anti #
kickback Statute (AKS)**
The Anti #
kickback Statute (AKS) is a federal law that prohibits the exchange of anything of value in return for referrals of federal healthcare program business, such as Medicare or Medicaid. The AKS is intended to prevent healthcare providers from engaging in fraudulent or abusive practices that could lead to unnecessary or excessive healthcare services being provided. Violations of the AKS can result in significant fines and criminal penalties.
**Breach of Confidentiality** #
**Breach of Confidentiality**
A breach of confidentiality occurs when private or sensitive information is disc… #
In healthcare, breaches of confidentiality can have serious consequences, including loss of trust between patients and healthcare providers, legal liability, and damage to the reputation of healthcare organizations.
**Clinical Laboratory Improvement Amendments (CLIA)** #
**Clinical Laboratory Improvement Amendments (CLIA)**
The Clinical Laboratory Improvement Amendments (CLIA) are federal regulations th… #
CLIA requires laboratories to be certified by the Centers for Medicare and Medicaid Services (CMS) and to meet certain standards for personnel, facilities, equipment, and testing procedures.
**Conditions of Participation (CoPs)** #
**Conditions of Participation (CoPs)**
Conditions of Participation (CoPs) are federal regulations that establish the re… #
CoPs cover a wide range of areas, including patient rights, quality of care, infection control, and medical record-keeping.
**Electronic Health Record (EHR)** #
**Electronic Health Record (EHR)**
An Electronic Health Record (EHR) is a digital version of a patient's medical re… #
EHRs typically include information such as medical history, medications, test results, and treatment plans. EHRs can be shared electronically between healthcare providers, which can improve the coordination and continuity of care.
**Emergency Medical Treatment and Active Labor Act (EMTALA)** #
**Emergency Medical Treatment and Active Labor Act (EMTALA)**
The Emergency Medical Treatment and Active Labor Act (EMTALA) is a federal law t… #
EMTALA is intended to ensure that patients receive necessary medical care in emergency situations, regardless of their financial or insurance status.
**False Claims Act (FCA)** #
**False Claims Act (FCA)**
The False Claims Act (FCA) is a federal law that prohibits the submission of fal… #
The FCA is often used to combat healthcare fraud, including billing fraud, kickback schemes, and the provision of unnecessary or excessive medical services. Violations of the FCA can result in significant fines and criminal penalties.
**Health Information Technology for Economic and Clinical Health (HITECH) Act** #
**Health Information Technology for Economic and Clinical Health (HITECH) Act**
The Health Information Technology for Economic and Clinical Health (HITECH) Act… #
The HITECH Act includes provisions to improve the privacy and security of electronic health information, as well as incentives for healthcare providers to adopt EHRs.
**Health Insurance Portability and Accountability Act (HIPAA)** #
**Health Insurance Portability and Accountability Act (HIPAA)**
The Health Insurance Portability and Accountability Act (HIPAA) is a federal law… #
HIPAA requires healthcare organizations to implement safeguards to protect PHI from unauthorized access, disclosure, or use. HIPAA also establishes requirements for the sharing of PHI between healthcare providers and insurance companies.
**Healthcare Quality Improvement Act (HCQIA)** #
**Healthcare Quality Improvement Act (HCQIA)**
The Healthcare Quality Improvement Act (HCQIA) is a federal law that provides li… #
HCQIA is intended to encourage healthcare professionals to report and address quality of care concerns without fear of retaliation or legal liability.
**Institutional Review Board (IRB)** #
**Institutional Review Board (IRB)**
An Institutional Review Board (IRB) is a committee that reviews and monitors res… #
IRBs are typically established by healthcare organizations or research institutions, and they are responsible for reviewing study protocols, informed consent documents, and other study-related materials.
**Licensure** #
**Licensure**
Licensure is the process by which a healthcare professional is granted the legal… #
Licensure typically requires the completion of an accredited education program, the successful completion of a licensing exam, and the fulfillment of other state-specific requirements.
**Medicaid** #
**Medicaid**
Medicaid is a federal #
state program that provides healthcare coverage to low-income individuals and families. Medicaid is administered by the states, but it is funded jointly by the federal government and the states. Medicaid covers a wide range of healthcare services, including hospitalizations, physician visits, and prescription medications.
**Medicare** #
**Medicare**
Medicare is a federal health insurance program that provides coverage to individ… #
Medicare is funded through payroll taxes, premiums, and general revenue. Medicare covers a wide range of healthcare services, including hospitalizations, physician visits, and prescription medications.
**Mental Health Parity and Addiction Equity Act (MHPAEA)** #
**Mental Health Parity and Addiction Equity Act (MHPAEA)**
The Mental Health Parity and Addiction Equity Act (MHPAEA) is a federal law that… #
The Mental Health Parity and Addiction Equity Act (MHPAEA) is a federal law that requires health insurance plans to provide equal coverage for mental health and substance use disorders as they