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8 compliance regulations in the United States health care

Understanding regulations can be difficult, especially considering the level of variation and complexity that lies within them. While no one expects you to know all the laws like the back of your hand, you should be able to understand what is expected from you, and what care you must provide for your patients. It is essential to abide by regulations to avoid costly repercussions, and to ensure you provide a high standard of care whilst fulfilling your healthcare obligations. Resources like medical compliance software can certainly help you, but to make things easier, we have compiled the most relevant 8 compliance regulations that you should be familiar with. 

1. Health Insurance Portability and Accountability Act (HIPAA) - This regulation outlines the boundaries on the use and release of health record information, and concerns the privacy of private patient data. It is a set of rules to aid in the appropriate safeguarding of patient data, as well as providing organizations with information concerning criminal penalties in the case of violations. It applies to all forms of patient records, and works to actively prevent fraud and identity theft. 
2. Health Information Technology for Economic and Clinical Health (HITECH) - Similar to HIPAA, these regulations are specific to health information technology, and specify that healthcare businesses must conduct regular audits to assess compliance with privacy rules. It ensures that patients are notified of who has access to certain information, and this protection of online information has become more important than ever given the current COVID climate. 
3. Medicare Access and Children’s Health Insurance Program (MACRA) - This addresses payment for doctors, as well as Medicare cost controls, outlining treatment models based on the quality of care. This also includes the use of electronic health records by medical practices and facilities.
4. Affordable Care Act of 2010 - This act provides healthcare professionals with the opportunity to play a larger role in the patient healthcare experience, as it outlines specifications concerning the provision of healthcare coverage. It allows higher quality services to be delivered, and reduces care expenses, increasing the protection of patients.
5. Hospital Readmissions Reduction Program (HRRP) - This requires Medicare and Medicaid services to reduce pay to facilities that have excessive readmission rates of patients. This allows for more patients to be treated without healthcare practices having to concern themselves with locating extra finances.
6. Healthcare Quality Improvement Act of 1986 (HCQIA) - This provides protection and immunity for healthcare providers and professionals in the case of law, and means health perspectives can be equally evaluated. It encourages audits and reviews and minimizes lawsuits from fellow physicians. 
7. Patient Safety and Quality Improvement Act of 2005 (PSQIA) - It’s often daunting to report unsafe conditions when your job could be at risk, and so this act was created to provide confidentiality and protection. Healthcare professionals can now report medical errors, without worrying about privacy. 
8. Chain of Custody (CoC) - Also known as a paper trail, a chain of custody allows you to show all evidence of interactions with patients and promotes good record-keeping. It will hold you accountable for your actions, and ensure that in the case of legal issues, you are protected.

How are local health departments structured and where do they get their regulatory authority?

Local health departments are usually structured quite differently, but their authority is all derived from the state. Typically, states have two country and municipality levels of government, which can vary depending on the type and size of jurisdictions. For example, in large cities, there may be a wider range of functions within health departments and they may have greater developments, technology, and staff than in state health departments. This means that smaller local health practices may have narrower health services. Regardless, all departments must practice regulatory compliance in accordance with state law and regulations when it comes to health, as what they say goes. 

In terms of governance structures, there’s a variety that is common in healthcare, and you may have heard of the following terms:

Centralized/state - Includes all local health departments, which are all units of state government

Local or decentralized - Local governments make the tax decisions and govern local health departments 

Mixed/hybrid system - The state government leads some local health departments, and the local government also leads some local health departments

Shared system - All local health departments are governed by state authorities and local authorities 

What impact does home rule have on a local government’s ability to regulate public health?

Sometimes local governments have the power to manage their own operations, depending on what certain states grant. As a result, this provides some governments with more authority than assumed under Dillon’s Rule, which specifies that local governments can only exercise power through explicit state grants, that are crucial to their existence, and fairly implied. This home rule system allows cities and counties to have a sense of government within themselves, as outlined through the state constitution. Under this home rule, law and policy making procedures can be transferred from the state legislature to local governments, which provides them with the ability to make their own decisions when it comes to public health. They have authority and autonomy to govern local departments, with greater flexibility in adapting and implementing healthcare standards and regulations that they see fit. This is great for local areas that suffer from specific healthcare issues that are exclusive to their geolocation, and with amended authority, there can be more rapid improvements in healthcare areas. 

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Further reading:

• Healthcare Laws & Regulations in U.S.
• Summary of the Public Health System in the United States