Nurse Executive Test Regulatory Frameworks & Compliance 4 — Questions and Answers
Question 1: A nurse executive is implementing a new restraint policy to comply with CMS regulations. Which patient population requires ADDITIONAL documentation requirements for restraint use under CMS CoPs?
- Patients in intensive care units requiring postoperative immobilization
- Patients in behavioral health settings where restraints are used for violent behavior (Correct answer)
- Patients in medical-surgical units receiving fall prevention restraints
- Patients in long-term acute care hospitals under Medicare Part A
Correct answer: Patients in behavioral health settings where restraints are used for violent behavior
CMS CoPs have specific, more stringent documentation and physician order requirements for restraints used in behavioral health settings for violent or self-destructive behavior.
Question 2: The Health Information Technology for Economic and Clinical Health (HITECH) Act strengthened HIPAA primarily by:
- Expanding the definition of protected health information to include genetic data
- Extending HIPAA obligations directly to business associates and increasing civil penalties (Correct answer)
- Requiring all healthcare providers to implement electronic health records by 2014
- Establishing the ONC as the primary enforcement body for HIPAA violations
Correct answer: Extending HIPAA obligations directly to business associates and increasing civil penalties
HITECH directly extended HIPAA Privacy and Security Rule obligations to business associates and significantly increased civil monetary penalty tiers.
Question 3: A state health department cites a hospital for violating a state licensure regulation that is MORE stringent than the corresponding federal CMS requirement. The hospital must comply with:
- The federal standard only, because federal law preempts less favorable state standards
- The state standard, because states may impose requirements that exceed federal minimums (Correct answer)
- Whichever standard is less burdensome for the organization to implement
- The federal standard while seeking a state waiver within 90 days
Correct answer: The state standard, because states may impose requirements that exceed federal minimums
Federal law generally sets a floor, not a ceiling; states may enact more stringent healthcare regulations and hospitals must comply with the higher state standard.
Question 4: When a nurse executive receives an OIG Advisory Opinion, its primary purpose is to:
- Provide a legally binding ruling applicable to all hospitals nationwide
- Give the requesting party OIG's view on whether a specific arrangement violates the AKS or other fraud statutes (Correct answer)
- Replace the need for legal counsel in healthcare compliance matters
- Establish new regulatory requirements that all providers must follow
Correct answer: Give the requesting party OIG's view on whether a specific arrangement violates the AKS or other fraud statutes
OIG Advisory Opinions are specific to the requesting party's arrangement and provide the OIG's assessment of risk under fraud and abuse laws, but are not binding on third parties.
Question 5: A nurse executive is responding to a sentinel event. Under TJC standards, a root cause analysis (RCA) must be completed within how many days of the event?
- 15 calendar days
- 45 calendar days (Correct answer)
- 60 calendar days
- 90 calendar days
Correct answer: 45 calendar days
TJC requires that a root cause analysis and action plan be completed and submitted within 45 calendar days of the sentinel event or of becoming aware of it.
Question 6: Under federal law, which type of healthcare organization is REQUIRED to have a compliance program as a condition of enrollment in Medicare or Medicaid?
- All licensed hospitals regardless of size
- Skilled nursing facilities (SNFs) as mandated by the ACA (Correct answer)
- Any provider that receives more than $500,000 annually from federal programs
- Critical access hospitals in states without deemed status agreements
Correct answer: Skilled nursing facilities (SNFs) as mandated by the ACA
The Affordable Care Act (ACA) mandated that skilled nursing facilities establish compliance and ethics programs as a condition of participation in Medicare and Medicaid.
Question 7: A nurse executive discovers that a vendor has offered nursing staff free tickets to a sporting event. Under OIG guidance on the Anti-Kickback Statute, the MOST appropriate action is to:
- Allow staff to accept if they disclose the gift on a conflict-of-interest form
- Refuse the offer and document the refusal in the compliance record (Correct answer)
- Accept the tickets but donate their monetary equivalent to a charity
- Report the vendor to the OIG exclusions database immediately
Correct answer: Refuse the offer and document the refusal in the compliance record
OIG guidance advises that items of value from vendors with a business relationship should be refused to avoid even the appearance of improper inducement under the AKS.
Nurse Executive Test Regulatory Frameworks & Compliance 4
A nurse executive is implementing a new restraint policy to comply with CMS regulations.
Which patient population requires ADDITIONAL documentation requirements for restraint use under CMS CoPs?