HCAD 650: Legal Aspects of Health Care Administration

Discussion 3 Questions –

Instructions: Please answer using your own words in a minimum of 400, maximum 550 words (2.5-3 paragraphs). PER QUESTION 3 in total. Referenced with Three (3) peer-reviewed journal articles or qualified text publish within the past five years and follow APA Manual 6th or 7th editions scholarly writing guidelines. APA in-text Citation formatting is required. When writing replies, please provide your experiences, new ideas, add probing questions to engage readers and new literature on the topic to enhance the learning opportunity.

Questions 1. Federal and State Regulation

Part 1: Critical Analysis of the Law

Address (Answer) ALL questions in part 1 in a minimum of 400, maximum 550 words

The Affordable Care Act (ACA) created a number of legal requirements. Review preventive service requirements at https://www.healthcare.gov/coverage/preventive-care-benefits/

1. Discuss the strengths and weaknesses of the current coverage of preventive services. Give reasons to support your discussion.
2. Birth control benefits and regulations have been controversial and have changed several times since the ACA was put in place. Evaluate the impact of current requirements on individuals, health care providers, health insurers, and religious employers. Support your conclusions with solid reasons.

Part 2: Strategic Application of the Law

Address (Answer) ALL questions in par 2 in a minimum of 400, maximum 550 words

You are the Vice President for Network Operations of Regnat Populus Health System, comprised of three hospitals and two clinics. The system is located in “the Delta,” the most rural parts of Arkansas. You want to inform the In-House Counsel (Attorney) and the Chief Medical Officer (CMO) about the value of telehealth.

1. Describe the Medicare and Medicaid populations serviced by the hospitals and clinics. Indicate how they will benefit from telehealth.
2. Find the laws of the state of Arkansas that pertain to telehealth. How will these laws impact your ability to implement telehealth services across the health system and clinics?
3. Discuss common legal barriers to telehealth. Make a recommendation on how to overcome these barriers. Support your recommendation with reasons.

Question 2. Medicare and Medicaid

Address (Answer) ALL questions in a minimum of 400, maximum 550 words

Medicare and Medicaid provide health insurance for many people and often lead the way in terms of health insurance policy reform.

1. CMS maintains an extensive list of Conditions of Participation (CoP). For what reason and how it is developed?
2. Who certifies providers’ compliance with the CoPs? Explain “Deemed Status”. Is the Joint Commission a regulatory agency? Why or why not? Is JCAHO accreditation mandatory? Why?
3. Explain the role of waivers with CMS. How do these contribute to the development of State Medicaid Plans (SPAs)?

Question 3: Fraud and Abuse Laws

Address (Answer) ALL questions in a minimum of 400, maximum 550 words

1. Consider the settlement in U.S. v. Halifax and the Corporate Integrity Agreement entered into by Halifax Hospital Medical Center, which addresses methods for preventing Anti-Kickback violations.

1. 1. What measures required by the Corporate Integrity Agreement do you believe will be most effective in preventing future violations?
   2. Which, if any, do you think will be least effective or ineffective in preventing future Anti-kickback violations? Explain your reasoning.

1. What is a Medicaid Integrity Plan? Who is responsible for creating and maintaining it? What does it cover?
2. The Physician Self-Referral law (Stark law) prohibits physician referral to designated health services (DHS) in which the physician or family member has an ownership interest. As a health care administrator what could you do to monitor this?
3. The False Claims Act is often linked to billing problems such as upcoding, billing for non-medically necessary services, services not provided, unbundled services, etc. What billing strategies could you implement to lessen the likelihood for a False Claims Act problem?

Attached are the readings you can also use others materials that you deem appropriate. Please make sure you 3 use in-text citations per question.