405 Healthcare

Health Care Law

Describe the health care law (75 to 150 words)

Analyze the importance of the law (75 to 150 words)

Analyze the impact the law has on health care resource allocation (75 to 150 words)

The Affordable Care Act

The ACA was passed by congress and signed into law by the president on March 23, 2010 and a final decision to uphold the law was rendered by Supreme court in 2012. The Act allows families, individuals, and small business owners in control of their health care. The cost of access to healthcare services is reduced by making health insurance more affordable by reducing premiums payable to healthcare insurance companies. The Act extends Medicaid, Medicare, and preserves CHIP, as well as simplifying enrollment.

The importance of the law is its multi-dimensional approach to provide accessibility of fair and affordable healthcare services to Americans. The law reduces the cost of healthcare insurance by reducing the amount payable in insurance premiums. The law eliminates out of pocket expenses for preventive services. Refundable tax credits are available providing premium assistance for coverage under specific qualified plans. The law strives to strengthen quality, affordable health care for all Americans. Lastly, the law provides education and training to healthcare professionals through loans and manageable repayment programs.

ACA has impacts on healthcare resource allocations requiring healthcare professionals to work toward ensuring access to health care, act to eliminate discrimination, and participate in correcting deficiencies in the availability, accessibility, and quality of services. Federal and state governments allocate billions of dollars in tax cuts while implementing the act. Healthcare insurance companies allocate funds to cover costs since the Act requires premiums paid to them be utilized to cover services. Institutions will allocate more resources such as employees and financial in order to provide care to the increased insured Americans.

Health Insurance Portability and Accountability Act

The United States Department of Health and Human Services issued the Privacy Rule to implement the requirement of the Health Insurance Portability and Accountability Act of 1996. The privacy rule standards address the use and disclosure of individual’s health information (United States Department of Health and Human Services, 2015). HIPPA includes lengthy rules and policies that users must understand and abide by to avoid incompliance. The likely benefits for practices include; Reduces efforts in business office, registration, and managing enrollments, referrals and eligibility ,reduces need for IS support of interface engine and EDI communication ,enables fee collection at time of service ,enables health plan/sponsor payments within 10 days and, reduces associated costs of the above (HIPAA News, 2010).

The importance is understanding the covered entities which include; Virtually all healthcare providers, including physicians, hospitals, long-term care providers, home health providers, dentists, ambulance services, etc. ,all healthcare payers, including health insurance and self-insured employer-sponsored health plans , and all healthcare clearinghouses that process or route electronic claims. Transactions performed electronically require HIPPA standards to be used. If covered entities are not required to use electronic transactions they may use paper and keep record. Providers are required to obtain a written patient authorization before releasing PHI for purposes other than treatment, payment, or Health Care Operations (HIPPA News, 2010). It is important for both providers and consumers to understand the standards of HIPAA so that all involved are protected. Patient participation is encouraged pertaining to decision making about their health and providing access to information by other providers.  

HIPPA requires federal and state government to allocate resources to implement the policy, security and transaction clauses of the law. Organizations must use resources to implement the four categories of HIPPA and security; administrative procedures, physical safeguards, and technical security mechanisms. Information must be protected and a conduction of risk assessment and a developed security plan which all is costly to the organization. Failure to comply would utilize resources to pay fines and penalties.

Health Information Technology for Economic and Clinical Health Act

(HITECH)

Health Information Technology for Economic and Clinical Health Act of 2009 provides HHS with the authority to establish programs to improve health care quality, safety, and efficiency through the promotion of health IT including electronic health records and private and secure electronic information exchange (United States Department of Health and Human Services, 2015). HITECH provided groundwork for a positive revolution in the delivery of health care. The key is compliance. HITECH provides positive and negative incentives. Positive incentives are distributed in the form of meaningful use payments and negative incentives are in the form of civil penalties and the threat of a prosecution at the state level (Burde, 2011).

The Act promotes information collection and storage kept in application of EHR systems which will eliminate access of information stored in a computer database. Healthcare providers are offered financial incentives for utilizing EHR’s. Implementation of the Act improves efficiency with elimination of paperwork and encourages compliance. In addition to HIPPA, although separate and unrelated, they do reinforce each other in ways.

Government allocates resources for the implementation of the EHR systems through payments or incentives for compliance of the Act. Financial resources are used by the healthcare organizations to update any requirements call for by the Act. Additional staff and training may also be required and funds needed to ensure compliance and avoid any breaches.

Emergency Medical Treatment and Active Labor Act (EMTALA)

EMTALA prohibits hospitals from improperly transferring emergency patients from one hospital to another in event they are unable to pay. Also known as the (anti-dumping) law. Hospitals must provide medical screening examinations to uninsured or Medicaid patients to ensure stability before transferring. In 2000, Congress enforced for the uninsured with penalties being consequences for not abiding.

The importance of the Act is to ensure those who have emergencies and lack payment receive emergency treatment. Hospitals have three main obligations under EMTALA. An individual requesting medical screening shall not be denied and the hospital must determine the emergency without delay to inquire payment. If emergency medical condition is present, treatment must be rendered, unless the hospital does not have capability of doing so, then appropriate transfer under provisions of EMTALA shall occur. Next, hospitals with specialized capabilities are obligated to accept transfers from hospitals who lack the capabilities.

Resources are ultimately paid by taxpayers. Although, hospitals and physicians have the greatest responsibility to provide the care. Health care insurance companies are known to deny claims for emergency visits based on diagnosis. Also attempts for preauthorization may be asked for resulting in denied payment. Penalties for violating EMTALA may result in costly resources being allocated for the hospital or physician. However, burden of uncompensated care is rising and decreasing resources for everyone and risking emergency departments the ability to care for all patients.