This document provides instructions for an assignment to evaluate and propose updates to a healthcare organization's policy related to regulatory compliance. Students are asked to either analyze a policy from their own workplace or a sample policy provided. They must identify areas of the policy that need updating based on current standards and guidelines, propose specific revisions, and analyze how the changes would help reduce litigation risks. Students must submit a 3-5 page executive summary of their analysis and recommendations.

1. 1. Policy Analysis
Introduction
Organizational policy alignment and adherence to laws and
regulations is critical for overall corporate compliance and to
decrease organizational risks (patient falls, medication errors,
cyber hacks and PHI data breaches, infection control, et cetera).
In this assignment, you will select, evaluate, and update one
health care provider’s policy related to a significant regulatory
risk to the health care organization.
Instructions
Select one of two options:
Option A
If you work for a hospital or health care organization you may
select a policy that is of interest to you then follow these
assignment instructions:
· Imagine you are a health care administrator at your current
employer. Analyze the policy you selected, taking into
consideration any recent changes. Evaluate what information
and where that information would need to be updated. Propose
revisions that are based on current identified standards and/or
new guidelines that you have researched in the text or identified
in other high-quality sources (that is, journals, government
websites, and the like). Analyze the significance of the selected
policy updates as it relates to potential litigation. (Why did the
policy need updating? What threats do these changes help
avoid?) Summarize your perspective on the revisions as well as
any additional changes that should be considered. Present your
work as an executive summary suitable for distribution to your
organization’s board members.
Option B
If you do not work in the industry or do not have access to a
health care policy, use the Hahnemann Falls Policy to complete
this assignment. Then follow these assignment instructions:
· As you can see, this policy was written in 2012. Now, imagine

2. you are a health care administrator working at the health care
organization where this policy originates from. Analyze the
policy, taking into consideration the changes in HIPAA and PHI
since 2012. Evaluate what information and where that
information would need to be updated for a current revision of
this document. Locate the areas where you would update or add
information to this 2012 version. Propose revisions that are
based on current identified standards and/or new guidelines that
you have researched in the text or identified in other high-
quality sources (that is, journals, government websites, and the
like). Analyze the significance of the selected policy updates as
it relates to potential litigation. (Why did the policy need
updating? What threats do these changes help avoid?)
Summarize your perspective on the revisions as well as any
additional changes that should be considered. Present your work
as an executive summary suitable for distribution to your
organization’s board members.
Your paper should be 3–5 pages long and should include a title
page and references for a total of 5–7 pages.
Strayer Writing Standards
This course requires the use of Strayer Writing Standards. For
assistance and information, please refer to the Strayer Writing
Standards link in the left-hand menu of your course.
Grading Criteria
The grading criteria for this executive summary is as follows. It
must include the elements listed below, so be sure to address
each point. You may also want to review the performance-level
descriptions for each criterion in the scoring guide to see how
your work will be assessed:
1. Analyze a problematic or dated health care policy, explaining
its primary purpose and effectiveness.
1. Determine the issues the selected policy poses as it is written
and any related ramifications.
1. Research the changes needed to update and align the policy
with current standards and guidelines.
1. Propose revisions that are based on current identified

3. standards and/or new guidelines.
1. Analyze the significance of the selected policy updates as it
relates to potential litigation.
1. Summarize personal perspective on the revisions as well as
any additional changes that should be considered.
1. Meet clarity, writing mechanics, and formatting
requirements.
1. By submitting this paper, you agree: (1) that you are
submitting your paper to be used and stored as part of the
SafeAssign™ services in accordance with the Blackboard
Privacy Policy; (2) that your institution may use your paper in
accordance with your institution's policies; and (3) that your use
of SafeAssign will be without recourse against Blackboard Inc.
and its affiliates.
Overview:
Assume you are a Maryland resident and Medicaid recipient
looking to enroll in a managed care plan, review the Maryland
Managed Care Website(s)
at: https://mmcp.health.maryland.gov/healthchoice/Pages/Health
Choice-Enrollment.aspx
https://mmcp.health.maryland.gov/healthchoice/pages/home.asp
x
Assess and evaluate HealthChoice, Maryland’s statewide
mandatory managed care program based on the following
evaluation criteria. Please choose one (1) of the MCO's under
HealthChoice to evaluate (e.g., Maryland Physician's Care).
Using the table format below, answer the questions (using a
narrative format) in each section that appear in bold type.
Please be sure to include a reference page.
HGMT 420 Assignment #5
Student Name:
Type your name here
Assignment #5 Title

4. HealthChoice/Maryland Managed Care Plan
Benefits Offered and Services Covered
You want a plan that offers a comprehensive benefits package
including preventive care as well as treatment programs for
chronic disease management. Also, you may need emergency
care and/or care away from home. What questions would you
ask to determine the benefits and covered services offered?
Evaluate the HealthChoice plan and summarize your findings .
Cost vs. Benefits
Managed care plans vary widely in the cost of services offered.
It may be tempting to base your selection primarily on the
periodic, out-of-pocket costs to you. You can’t be sure that the
least expensive plan will give you all the medical services you
need. Review cost vs. benefits for the HealthChoice plan
carefully and summarize your findings.
Services of the Primary Care Physician
Choosing your primary care physician (PCP) may be the most
important decision you make when enrolling in a managed care
plan. The following questions are important when choosing your
plan: Please answer each question.
· Can you choose more than one PCP for your family?
· Is there a large choice of primary care doctors and specialists?
· How long is the average wait to get an appointment with the
chosen PCP?
· Can you see the same doctor consistently?
· When and how can you change doctors if you are dissatisfied
How does HealthChoice measure up?
Prescription Drug Benefits
When evaluating a health plan it is very important to know what
kind of prescription drug benefits the plan offers. Depending
upon the plan, there are several systems that have been
implemented in efforts to control costs. Some plans offer a
“generic only” plan. What prescription drug benefits does
HealthChoice offer? Are they beneficial to your current drug
regimen?

5. Provider Network and Geographic Service Area
Be sure you inquire from the Provider Membership Directory
which providers are included in the network and where they are
located in your community. If you live in one community and
work in another; determine if routine care can be received in
either location. Does HealthChoice have a strong network of
Providers in a geographic area that is amenable to you? Must
you go to different locations for different services? If you have
a child away at school, does the network extend to that area?
Commitment to Quality of Care and Service
What measures of quality care and satisfaction of service are
available? It is worthwhile to find out if the plan has been
accredited by the National Committee for Quality Assurance
(NCQA). NCQA is the most common accrediting body for
network plans. Review and report on what measures of quality
care and satisfaction are available for HealthChoice.
Customer Satisfaction
How do enrolled members feel about the plan? There are
various objective forms of measurement used to determine
“quality services” given by managed care plans such as
accreditation, HMO report cards and/or publications produced
by the industry. You would be wise to look at any that measure
customer satisfaction. The National Committee for Quality
Assurance (NCQA) mission is to provide information that
enables purchasers and consumers of managed health care to
compare plans based on quality. Their web site may be reached
at http://www.ncqa.org/
Limitations, Maximums, or Exclusions
Lifetime Cap refers to the maximum dollar amount of benefits
available to a consumer in a managed care plan during his or
her lifetime. This amount becomes important when confronted
with a life-threatening disease or accident that requires
prolonged care involving expensive therapeutic intervention and
support. Does HealthChoice outline limitations, maximums, or
exclusions?