PBC Regulatory Compliance & Legal Framework 2 — Questions and Answers
Question 1: Under HIPAA, which action is permissible when sharing a deceased patient's perinatal loss records with a family member?
- Share all records without restriction since the patient is deceased
- Disclose records to a personal representative unless doing so would endanger someone (Correct answer)
- Require a court order before any disclosure to family members
- Automatically share all records with the next of kin listed in the chart
Correct answer: Disclose records to a personal representative unless doing so would endanger someone
HIPAA allows disclosure of a deceased individual's PHI to personal representatives, but providers may decline if they believe it could endanger someone.
Question 2: Which federal law requires hospitals to provide information about advance directives to patients upon admission, which may be relevant in perinatal end-of-life situations?
- Emergency Medical Treatment and Labor Act (EMTALA)
- Patient Self-Determination Act (PSDA) (Correct answer)
- Health Insurance Portability and Accountability Act (HIPAA)
- Americans with Disabilities Act (ADA)
Correct answer: Patient Self-Determination Act (PSDA)
The Patient Self-Determination Act requires healthcare facilities to inform patients of their rights to make advance directives regarding their own care.
Question 3: When a fetal death occurs after 20 weeks of gestation, most U.S. states require which document to be filed?
- A death certificate only
- A fetal death certificate (stillbirth certificate) (Correct answer)
- A birth certificate and a death certificate
- An incident report to the state health department
Correct answer: A fetal death certificate (stillbirth certificate)
Most states require a fetal death certificate for losses at or after 20 weeks gestation, though some states have lower gestational thresholds.
Question 4: A perinatal bereavement counselor is subpoenaed for medical records relating to a patient's pregnancy loss. What is the appropriate first step?
- Immediately provide all requested records to comply with the subpoena
- Consult with the facility's legal counsel before releasing any records (Correct answer)
- Refuse to comply because mental health records are always privileged
- Notify the patient only if she requests notification
Correct answer: Consult with the facility's legal counsel before releasing any records
A subpoena is a legal order but does not automatically override HIPAA; legal counsel must review before disclosure to determine proper authorization.
Question 5: Under the Affordable Care Act, mental health and substance use disorder benefits must be provided at parity with medical benefits. How does this affect perinatal bereavement services?
- Hospitals are exempt from parity rules for grief counseling
- Insurers cannot impose more restrictive limits on bereavement counseling than on comparable medical services (Correct answer)
- Parity only applies to inpatient psychiatric services, not outpatient grief support
- Parity rules only apply to employer-sponsored plans with 500 or more employees
Correct answer: Insurers cannot impose more restrictive limits on bereavement counseling than on comparable medical services
Mental Health Parity rules require that grief counseling and bereavement support cannot face more restrictive cost-sharing or visit limits than equivalent medical services.
Question 6: Which organization sets accreditation standards that may require hospitals to have bereavement support programs as part of patient-centered care?
- The Joint Commission (TJC) (Correct answer)
- The Centers for Medicare & Medicaid Services (CMS) only
- The American Medical Association (AMA)
- The National Institute of Mental Health (NIMH)
Correct answer: The Joint Commission (TJC)
The Joint Commission's patient-centered care standards can require hospitals to address psychosocial and bereavement needs as part of comprehensive care.
Question 7: A nurse is required by her employer to complete mandatory reporting for suspected child abuse. A patient discloses that her previous pregnancy loss was due to domestic violence. What is the nurse's obligation?
- Report only if the patient is currently pregnant
- Report the domestic violence as suspected child abuse since a fetal death occurred
- Follow mandatory reporting laws for domestic violence if applicable in that state (Correct answer)
- Take no action because the loss was a pregnancy, not a living child
Correct answer: Follow mandatory reporting laws for domestic violence if applicable in that state
Mandatory reporting obligations vary by state; some states require reporting domestic violence to authorities, and practitioners must follow their jurisdiction's specific laws.
PBC Regulatory Compliance & Legal Framework 2
Under HIPAA, which action is permissible when sharing a deceased patient's perinatal loss records with a family member?