Healthcare Policy & Legislation Flashcards

Which federal agency is responsible for enforcing HIPAA Privacy and Security Rules?

Answer: Office for Civil Rights (OCR) within the Department of Health and Human Services

The OCR is the primary federal agency tasked with investigating HIPAA complaints and enforcing the Privacy and Security Rules against covered entities and business associates.

A healthcare organization's compliance program should include all of the following elements recommended by the OIG EXCEPT:

Answer: Guaranteed immunity from federal prosecution for all compliance violations discovered internally

The OIG's model compliance program elements do not include immunity from prosecution; a compliance program can mitigate risk but does not guarantee immunity.

Under HIPAA's Minimum Necessary standard, covered entities must:

Answer: Limit the use and disclosure of PHI to the minimum amount needed to accomplish the intended purpose

The Minimum Necessary standard requires covered entities to make reasonable efforts to limit PHI access and disclosure to what is needed for a specific purpose.

The Balanced Budget Act of 1997 significantly affected Medicare by:

Answer: Creating the Medicare+Choice program (later renamed Medicare Advantage) and introducing prospective payment for home health

The BBA of 1997 introduced Medicare+Choice to expand managed care options and implemented prospective payment systems for post-acute care including home health agencies.

Which of the following best describes 'value-based purchasing' in CMS payment reform?

Answer: Tying a portion of provider reimbursement to quality and efficiency metrics rather than paying purely for volume of services

Value-based purchasing programs reward providers financially for delivering high-quality, efficient care, shifting payment from fee-for-service volume to outcomes-based performance.

The Children's Health Insurance Program (CHIP) is designed to provide coverage to:

Answer: Children in families with incomes too high for Medicaid but who cannot afford private insurance

CHIP targets children in low-to-moderate income families who earn too much to qualify for Medicaid but lack affordable access to private coverage.

The No Surprises Act, effective January 2022, primarily protects patients from:

Answer: Unexpected out-of-network charges for emergency care and certain non-emergency services at in-network facilities

The No Surprises Act limits out-of-network cost-sharing for emergency services and certain non-emergency services provided at in-network facilities without prior patient notice.