To help simplify law regulation requirements, we have compiled the most essential regulations that you should be familiar with within your practice.
Healthcare Quality Improvement Act of 1986 (HCQIA)
This act provides immunity for medical professionals and organizations during conduct assessments, in order to avoid violation and abuse in the peer review physician process. While this law continually undergoes new developments and amendments as new rulings are made, it essentially protects medical practitioners from lawsuits from fellow physicians. It promotes complaints to be filed through an official process, which also avoids further turmoil.
A commonly heard term, Medicare outlines the insurance coverage for almost 50 million Americans. It ensures that almost all citizens are eligible for healthcare insurance, and it provides wide coverage of a variety of health issues.
Building upon the existence of Medicare, Medicaid aims to provide healthcare insurance for low-income individuals and families. This is a very extensive program that annually reimburses hospitals for over 50% of their medical expenses, and covers a wide range of demographics. These include temporarily unemployed workers and disabled individuals, with this program representing the highest coverage rate in the United States.
Children’s Health Insurance Program (CHIP)
This program was enacted for health insurance pertaining to children specifically, as it supports families from low-income households to be able to provide for their young ones. It works to provide for underprivileged children, and ensures they have access to the same high-quality healthcare as all other American citizens, and that they are able to develop healthily. Because of the Affordable Care Act, this program is accessible to the largest number of low-income children in all the United States.
Hospital Readmissions Reduction Program (HRRP)
As another Affordable Care Act initiative, this program ensures that the Centers for Medicare and Medicaid Services (CMS) reduce payouts to healthcare facilities that experience a particularly high number of patient readmissions. Over time, these can be excessive and can incur large expenses, so this program works to reduce the amount spent. Specifically, this is for patients who experience conditions such as heart failure and pneumonia, as well as multiple illnesses, comorbidity, and poor health.
Health Insurance Portability and Accountability Act (HIPAA) of 1996
This act protects staff in allowing health insurance policies to be carried from job to job, as well as ensuring that patient information is protected and held confidential. It makes sure that insurance companies cannot deploy discrimination against certain patients or healthcare workers, and it protects all insurance rights. In the case that worker applications are denied, HIPAA allows these individuals to apply for coverage outside of their normal enrollment period, and can also accommodate family changes such as marriages and births.
Patient Safety and Quality Improvement Act (PSQIA) of 2005
This act encourages workers to report dangerous working conditions, as it protects the confidentiality of those who come forward. It promotes medical error reporting, and levies fines for any confidentiality breaches that are made. In addition to this, the act also publishes a list of patient safety organizations that analyze patient data in order to maintain transparency, and improve patient safety policies. This way, healthcare systems can continually work on identifying weaknesses and making necessary improvements to improve the patient experience and clinical outcomes.
Affordable Care Act of 2010
As the final regulation on this list, this act requires that most American citizens apply for health insurance coverage, with a penalty enacted for those who fail to do so. All enterprises that employ more than 200 workers must provide healthcare insurance coverage to their staff, and all those eligible must have the option to be able to review and compare their plans at any time. Input from this system is used to promote better delivery care services, and it ensures that all Americans have access to the resources they need.