NR 442 Matrix Exam 2

NR 442 Matrix Exam 2 Chp: 4, 10, 11, 12, 13, 14, 19, 21, 23, 24, 25, 28 ● Legislation related to health care o Factors influencing legislation ▪ Federal policies and practices influence local and state governments ▪ Coordination of services under department of health and human services o Gov’t role in health policy at local, state, and national levels ▪ Local: Local health departments (LHD) - Receives funds from the state level to implement community level programs. ● The primary focus of a local health department is the health of its citizens ● Local health departments offer various services and programs ● Local health departments are responsible for identifying and intervening to meet the health needs of the local community ● Local health departments work closely with local officials, businesses, and stakeholders. ● Local health departments report notifiable communicable diseases to state departments of health ● Nurses at the community level typically function in the nursing roles of caregiver, advocate, case manager, referral source, counselor, educator, outreach worker, disease surveillance expert, community mobilizer, and disaster responder. ● Funded through local taxes with support from federal and state funds. ▪ State: State departments of health: Obtain funding from state legislature and federal public health agencies. ● Manages the Women, Infants, and Children (WIC) program, which promotes nutrition for women, infants, and children up to age five who are of low socioeconomic status. ● Oversees Children’s Health Insurance Program (CHIP), which offers expanded health coverage to uninsured children whose families do not qualify for Medicaid. ● Establishes public health policies ● Provides assistance/support for local health departments ● Responsible for the administration of the Medicaid program ● Reports notifiable communicable diseases within the state to the CDC ● State boards of nursing: o Development and oversight of the state’s nurse practice act. o Licensure of registered and licensed practical nurses. o Oversight of the states school of nursing. ▪ Federal: Most health related activities at the federal level are implemented and administered by the United States Department of Health and Human Services, which consists of 11 major agencies. The HHS is: ● Under the direction of the Secretary of Health ● Funded through federal taxes ● Veterans Health Administration: Finances health services for active and retired military persons and dependents (within the U.S. Department of Veterans Affairs) ▪ National: WHO ● Provides daily information regarding the occurrence of internationally important diseases. ● Establishes world standards for antibiotics and vaccines ● Primarily focuses on the health care workforce and education, environment, sanitation, infectious diseases, maternal and child health, primary care. ▪ Government agencies: The 11major agencies that the HHS oversees are: o Administration for Community Living (ACL) o Administration for Children and Families (ACF) o Centers for Medicare and Medicaid Services (CMS) o Agency for Healthcare Research and Quality (AHRQ) o Centers for Disease Control and Prevention (CDC) o Agency for Toxic Substances and Disease Registry (ATSDR) o Food and Drug Administration (FDA) o Health Resources and Service Administration (HRSA) o Indian Health Services (IHS) o National Institutes of Health (NIH) o Substances Abuse and Mental health Services Administration (SAMHSA) o Hill-Burton Act ▪ In 1946, Congress passed a law that gave hospitals, nursing homes and other health facilities grants and loans for construction and modernization. ▪ Federal assistance in construction of hospitals with stipulations about service for the uninsured, ▪ Federal assistance/grants to construct hospitals, rural hospitals, nursing homes, health facilities with stipulations about service for uninsured patients. ▪ Treat regardless of race, nationality, financial background, medicare or medicaid status ▪ U.S. federal law passed in 1946 o COBRA ▪ Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) ▪ Required all EDs that participate in Medicare to provide care for all, regardless of ability to pay ▪ Ensured continuation of insurance after loss of job ▪ Example of how federal government can affect state health care practices o Social Security Act ▪ Social Security Act of 1935; 1965; 1972 ▪ Benefits for mothers, children, elderly, disabled ▪ Social Security Act of 1935 and its amendments (1965, 1972): The Social Security Act and its subsequent amendments have had a far-reaching effect on health care for many groups. The Social Security Administration (SSA) provides welfare for high-risk mothers and children. Benefits were later expanded to include health care provisions for older adults and the handicapped. This major governmental action was the enactment of legislation for Medicare and Medicaid. o Medicare and Medicaid ▪ Medicare (Title XVIII) in 1965 ● Health care services for people over 65, with permanent disabilities, and those with end-stage renal disease. This federal program, administered by the Centers for Medicare and Medicaid Services (CMS; formerly Health Care Financing Administration [HCFA]), pays specified health care services for all people 65 years of age and older who are eligible to receive Social Security benefits. People with permanent disabilities and those with end-stage renal disease are also covered. The objective of Medicare is to protect older adults and the disabled against large medical outlays. The program is funded through a payroll tax of most working citizens. Individuals or providers may submit payment requests for health care services and are paid according to Medicare ▪ Medicaid (Title XIX of the socials security act) in 1965 ● Joint state and federal program ● Universal health care coverage for: indigent, children, women, disabled, impoverished elders, and adults below poverty line in some states. ● Medicaid, Title XIX Social Security Amendment (1965): Each state is allocated federal dollars on a matching basis (i.e., 50% of costs are paid with federal dollars). Each state has the responsibility and right to determine the services to be provided and the dollar amount allocated to the program. ● Basic services (e.g., ambulatory and inpatient hospital care, physical therapy, laboratory, radiography, skilled nursing, and home health care) are required to be eligible for matching federal dollars. ● States may choose from a wide range of optional services, such as, inpatient and outpatient hospital care, pregnancy-related care, vaccines for children, family planning services, rural health clinics, home health care, laboratory and x-ray services, and Early and Periodic Screening, Diagnostic and Treatment (EPSDT). ● Limits are placed on the amount and duration of service. Unlike Medicare, Medicaid provides long-term care services (e.g., nursing home and home health) and personal care services (e.g., chores and homemaking). In addition, Medicaid has eligibility criteria based on level of income. ● Inpatient care ● Out of pocket costs ● Prescription drug coverage ● Part A: Covers hospital insurance, including inpatient care o Deductible for health services o Does not pay for all health care costs o Co-payments required after 60 days ● Part B: out of pocket costs, additional monthly fee, helps pay for o Physician services o Hospital outpatient care o Durable medical equipment o Other services, including some home health care ● Part C: o Medicare Advantage Plans o Optional “gap” coverage o Provided by private insurance companies approved by Medicare May include HMOs and PPOs o May include vision, hearing, dental care, and other services not covered by Medicare Parts A, B, or D ● Part D: Prescription drug coverage, initiated in 2006 o Optional; must enroll in an approved prescription drug plan o Monthly premium, deductibles, and co-payments o Must pay 100% of costs when costs reach “coverage gap” or “donut hole” o Penalties for late enrollment o Mental Health laws ▪ Mental Health Parity and Addictions Equity Act of 2008 ▪ Financial requirements (deductibles, co-payments) and treatment limitations (number of visits; days of coverage) that apply to mental health benefits must be no more restrictive than the predominant financial requirements or treatment limitations that apply to substantially all medical/surgical benefits.