HAC Healthcare Policy & Legislation 1 — Questions and Answers
Question 1: Which federal law primarily governs the privacy and security of protected health information (PHI) in the United States?
- Health Insurance Portability and Accountability Act (HIPAA) (Correct answer)
- Affordable Care Act (ACA)
- Emergency Medical Treatment and Labor Act (EMTALA)
- Health Information Technology for Economic and Clinical Health Act (HITECH)
Correct answer: Health Insurance Portability and Accountability Act (HIPAA)
HIPAA established national standards for protecting PHI and governs how covered entities and business associates handle patient information.
Question 2: Under the Affordable Care Act (ACA), what is the primary purpose of the Independent Payment Advisory Board (IPAB)?
- To propose Medicare spending reductions when growth exceeds targets (Correct answer)
- To approve new prescription drugs for Medicare coverage
- To set Medicaid eligibility thresholds for states
- To oversee the Health Insurance Marketplace enrollment process
Correct answer: To propose Medicare spending reductions when growth exceeds targets
The IPAB was designed to recommend Medicare spending cuts when per-capita growth exceeded a defined threshold, keeping cost growth in check.
Question 3: EMTALA requires hospitals with emergency departments to:
- Provide a medical screening exam and stabilize any emergency condition regardless of ability to pay (Correct answer)
- Accept only patients referred by in-network physicians
- Obtain pre-authorization from insurers before providing emergency care
- Discharge patients within 24 hours of stabilization to reduce costs
Correct answer: Provide a medical screening exam and stabilize any emergency condition regardless of ability to pay
EMTALA mandates that covered hospitals screen and stabilize patients with emergency conditions without regard to insurance status or ability to pay.
Question 4: Which of the following best describes the role of the Centers for Medicare & Medicaid Services (CMS) in healthcare policy?
- CMS administers Medicare, Medicaid, CHIP, and oversees health insurance market standards (Correct answer)
- CMS approves new pharmaceutical drugs before they reach the market
- CMS licenses healthcare professionals at the state level
- CMS manages the National Institutes of Health research grant program
Correct answer: CMS administers Medicare, Medicaid, CHIP, and oversees health insurance market standards
CMS is the federal agency responsible for administering Medicare, Medicaid, CHIP, and implementing ACA insurance market rules.
Question 5: The False Claims Act (FCA) is primarily used in healthcare to address:
- Fraudulent billing and false claims submitted to government healthcare programs (Correct answer)
- Privacy breaches involving unauthorized disclosure of patient records
- Upcoding of diagnosis codes on private insurance claims
- Medication errors that result in patient harm
Correct answer: Fraudulent billing and false claims submitted to government healthcare programs
The FCA imposes liability on individuals and companies that submit fraudulent claims for payment to federal healthcare programs like Medicare and Medicaid.
Question 6: Which federal program provides health coverage to low-income individuals and families and is jointly funded by states and the federal government?
- Medicaid (Correct answer)
- Medicare Part A
- CHIP (Children's Health Insurance Program)
- TRICARE
Correct answer: Medicaid
Medicaid is a joint federal-state program that provides health coverage to eligible low-income adults, children, pregnant women, elderly, and people with disabilities.
Question 7: The HITECH Act of 2009 strengthened HIPAA by:
- Increasing penalties for HIPAA violations and expanding breach notification requirements (Correct answer)
- Creating new federal standards for electronic prescribing of controlled substances
- Establishing the federal Health Insurance Marketplace
- Mandating that all hospitals adopt electronic health records by 2014
Correct answer: Increasing penalties for HIPAA violations and expanding breach notification requirements
HITECH significantly increased civil and criminal penalties for HIPAA violations and introduced mandatory breach notification rules for covered entities and business associates.
HAC Healthcare Policy & Legislation 1
Which federal law primarily governs the privacy and security of protected health information (PHI) in the United States?