Healthcare Policy & Legislation Flashcards

Under Medicare, what does 'Part D' specifically cover?

Answer: Prescription drug coverage

Medicare Part D provides optional prescription drug coverage through private plans approved by Medicare.

Which ACA provision expanded access to preventive services by requiring most health plans to cover them:

Answer: Without cost-sharing (no copays or deductibles) for in-network services

The ACA mandates that non-grandfathered health plans cover USPSTF Grade A and B preventive services without imposing any cost-sharing on patients.

The Stark Law (Physician Self-Referral Law) prohibits physicians from:

Answer: Referring Medicare patients to entities in which they have a financial relationship, with limited exceptions

The Stark Law bars physicians from referring Medicare patients for designated health services to entities where the physician or immediate family has a financial interest, unless an exception applies.

What is the primary purpose of a Certificate of Need (CON) law in healthcare?

Answer: To require state approval before healthcare facilities can expand or add certain services

CON laws require healthcare organizations to obtain state approval demonstrating community need before building facilities, purchasing major equipment, or adding new services.

The Anti-Kickback Statute (AKS) makes it illegal to:

Answer: Offer, pay, solicit, or receive remuneration to induce or reward referrals of federal healthcare program business

The AKS prohibits any exchange of value intended to influence referrals for services covered by federal healthcare programs like Medicare and Medicaid.

Under the ACA, health insurance marketplaces (exchanges) primarily serve which population?

Answer: Individuals and small businesses purchasing insurance who do not have access to affordable employer coverage

ACA marketplaces were designed to give individuals and small employers a structured place to shop for private health insurance, often with premium tax credits for eligible buyers.

The 340B Drug Pricing Program requires pharmaceutical manufacturers to provide discounted drugs to:

Answer: Qualifying safety-net healthcare providers serving high proportions of low-income patients

The 340B program mandates deep discounts from drug manufacturers to covered entities such as federally qualified health centers, rural referral centers, and disproportionate share hospitals.