A synopsis of United States Code, Federal Register, Code of Federal Regulations, and state regulations that are applicable to patients, providers, third-party payers, and administrators involved in health care industry.
The United States Code
As stated by the GPO (2008), “the United States Code is the codification by subject matter of the general and permanent laws of the United States. It is divided by broad subjects into 50 titles and published by the Office of the Law Revision Counsel of the U.S. House of Representatives. Since 1926, the United States Code has been published every six years. In between editions, annual cumulative supplements are published in order to present the most current information” (p.2). The relevance of the United States Code for patients, provides, third-party payers, and administrators centers on applicable rights regarding access to health care, laws governing pre-existing conditions, and liabilities. A prime example would be title 42, public health and welfare act, Chapter 7 health insurance for aged and disabled. The GPO cites (2008), “an organization which provides medical and other health services (or arranges for their availability) on a prepayment basis (and either is sponsored by a union or employer, or does not provide, or arrange for the provision of, any inpatient hospital services) may elect to be paid 80 percent of the reasonable cost of services for which payment may be made under this part on behalf of individuals enrolled in such organization in lieu of 80 percent of the reasonable charges for such services if the organization undertakes to charge such individuals no more than 20 percent of such reasonable cost” (p.4). Medicare and Medicaid regulations are very stringent and fall under proper coding via the MDS coordinator (Minimum Data Set) for Long-Term care facilities. This to insure that proper billing is applied to each patient receiving skilled care and long term care, thus reducing the possibility of fraudulent billing practices.
As stated by the United States Department of Education (2008), “the Federal Register is the official daily publication for rules, proposed rules, and notices of Federal agencies and organizations, as well as executive orders and other presidential documents” (p.1). Thus applicable and pertinent rulings are maintained according to subheadings and deemed public notices, rules, and proposed rulings. A specific and primary example centers on HIPPA rules and implementations within health care settings: The GPO states (2008), “The Department of Justice (Department) is issuing this notice of proposed rulemaking (NPRM) in order to: Adopt enforceable accessibility standards under the Americans with Disabilities Act of 1990 (ADA) that are “consistent with the minimum guidelines and requirements issued by the Architectural and Transportation Barriers Compliance Board” (Access Board); and perform periodic reviews of any rule judged to have a significant economic impact on a substantial number of small entities, and a regulatory assessment of the costs and benefits of any significant regulatory action as required by the Regulatory Flexibility Act, as amended by the Small Business Regulatory Enforcement Fairness Act of 1996 (SBREFA)” (p.1). This information would benefit patients regarding their rights to privacy and it would also benefit providers, third-party payers, and administrators regarding proper compliance with the individual HIPAA requirements, thus possibly avoiding legal liability ramifications.
Code of Federal Regulations
The Library of Congress cites (2008), “the Code of Federal Regulations (CFR) is the codification of the general and permanent rules published in the Federal Register by the executive departments and agencies of the Federal Government. It is divided into 50 titles that represent broad areas subject to Federal regulation. Each volume of the CFR is updated once each calendar year and is issued on a quarterly basis” (p.1). The federal regulations range from general provisions, to federal elections, banking, and labor laws. However, an applicable regulation regarding health care corresponds to title 42 public health, primarily pertaining to three aspects: public health service, centers for Medicare and Medicaid services, and office of inspector general-health care, department of health and human services. The code of federal rules is maintained and adherence is maintained through federal and state regulations. Interestingly, the general public has a right to participate and amend specific rulings. The Federal Register cites (2007), “citizens have a right to express their views before an agency adopts final rules; furthermore, citizens have the right to voice concerns applicable in accordance to federal rules” (p.2). The relevance of this for patients centers on participation in their own positive health care outcomes. For providers and administrators, proper compliance regarding federal rulings can be maintained and established via ongoing education.
State of Tennessee, Department of Health and Human Services:
The Tennessee Department of Health and Human Services (TDHS) is set up to accommodate variants of care for the citizens of Tennessee. Thus they provide services ranging from adult protection, child protection, food stamps, and Medicaid. According to the Tennessee DHS office (2007), “the Department of Human Services employees receive statewide training on Title VI compliance each year. As a result of this training, everyone has been made aware that Title VI prohibits discrimination on the basis of race, color, or national origin in any program or activity that receives federal funds or other federal financial assistance. In order to ensure compliance with all aspects of Title VI, the department must take steps to make certain that our growing ethnically diverse population is served equitably and that they have meaningful access to all programs” (p.1). This is an important aspect in the sense of compliance and funding, without proper compliance, patients, providers, and administrators run the risk of decreased funding and coverage for specific disease progressions.
Government Printing Office (2008). The United States Code: Main page (Links to an external site.). Retrieved September 1, 2015 from http://www.gpo.gov/
Tennessee Department of Human Services (2007). Guidance for family assistance staff: citizenship, immigration status, and social security numbers. (Links to an external site.) Retrieved September 1, 2015 from http://www.tennessee.gov/humanservices
The Federal Register (2007). The Federal Register: what it is and how to use it (Links to an external site.). Retrieved June 2, 2015 from http://www.archives.gov/federal-register/tutorial/online-html.html#public
The Library of Congress (2008). The legislative process (Links to an external site.). Retrieved June 2, 2015 http://thomas.loc.gov/.
United States Department of Education (2008). Federal register documents — U.S. Department of Education (Links to an external site.). Retrieved June 2, 2105 from http://www.ed.gov/news/fedregister/index.html
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