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The document discusses Conditions of Participation (CoPs) and Conditions for Coverage (CfCs), which are health and safety regulations that must be met by Medicare and Medicaid providers. The CoPs help ensure high quality care and quality improvement. CMS establishes CoPs or CfCs for various healthcare organizations and provider types. Revisions are made to the CoPs in response to statutory changes, administration policies, national issues, medical practice changes, and other factors. Current priority issues in revising the CoPs include reducing healthcare acquired conditions, avoidable hospital readmissions, regulatory burden on providers, and improving antibiotic stewardship.
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The document discusses patient privacy regulations and consequences for violations. It summarizes a case where 120 UCLA hospital staff inappropriately accessed celebrity medical records between 2004-2006. One nurse was fired and two others warned. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule protects individual health information and applies to health plans, providers, and their business associates. Violations can result in fines up to $1.5 million and imprisonment. Individual staff who violate patient privacy also face warnings, suspension, and firing.
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Over 120 UCLA hospital employees improperly accessed and viewed celebrity patient files, violating patient confidentiality. Patient confidentiality is protected by law and requires that personal medical information be kept private except for necessary healthcare purposes. Violating confidentiality can result in fines or imprisonment, with penalties increasing depending on the severity and intent of the violation. Hospitals must implement ongoing privacy trainings and monitoring to avoid such breaches.
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2) It examined current principles of patient consent and how they impact the healthcare industry.
3) It reviewed physicians' rights and responsibilities in treatment, as well as current and future trends.
4) It provided an overview of the Health Insurance Portability and Accountability Act (HIPAA) and issues of privacy and confidentiality.
5) It addressed legal and ethical obligations around medical record documentation, storage, and use now and in the future.
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1) Key terminology like torts, negligence, and malpractice. It defines civil and criminal law.
2) Increased responsibilities and risks for nurses including advanced practice nurses.
3) Types of civil wrongs like intentional torts, invasion of privacy, and negligence.
4) How to prevent liability issues through proper communication, documentation, and following standards of care.
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3) Reforms are changing the US healthcare delivery system to improve safety and quality through organizations like the Institute of Medicine.
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The document discusses key aspects of the US health care system including:
1) The Patient Protection and Affordable Care Act which reformed the US health care system.
2) Measuring national health through reports like Healthy People 2020 and comparing US health indicators to other countries.
3) Concerns around sedentary lifestyles, obesity, and chronic illness in the US and efforts to address health disparities.
Welcome to the hippa, privacy and security
This document provides an overview of patient privacy and confidentiality requirements under HIPAA. It discusses how confidential patient information should only be accessible to authorized medical professionals and defines examples of privacy violations. Consequences for violations include fines ranging from $100 to $50,000 depending on the nature of the violation. The document recommends ways for medical staff to avoid violations such as not discussing private patient information in public areas, logging off computers properly, and only sharing information with authorized individuals. Employers are responsible for implementing security procedures and training staff annually on confidentiality policies.
Corruption in provision of health services
Corruption in the health sector takes many forms and has detrimental impacts. It undermines equitable access to care, increases costs, and deprives people of their right to health. Common types of corruption include informal payments to providers, absenteeism, procurement corruption, and theft of medicines. Underlying causes include lack of accountability, oversight, and standards. Measures to control corruption require a tailored approach and include preventive guidelines, transparency, monitoring, and ensuring good behavior is rewarded and bad behavior punished. Without controlling corruption, public trust in the health system is compromised.
Integrity and Corruption in the Health Sector by Dr Musa Ajlouni
This document discusses integrity, corruption, and their manifestations in the health sector. It defines integrity and corruption, then outlines how corruption occurs among various actors in the health system, including regulators, payers, health care providers, patients, and suppliers. It describes both monetary and non-monetary forms of corruption. The document also discusses underlying causes of corruption in health and potential remedies, emphasizing the need for transparency, accountability, and a culture of integrity.
Healthcare Compliance Presentation
This document summarizes a presentation on healthcare compliance. It discusses how mandatory compliance requirements have increased in recent years through various laws and regulations. Specifically, the Affordable Care Act requires companies to have compliance programs with core elements in place by March 2013 or risk exclusion from federal healthcare programs. The presentation recommends that organizations conduct background checks on all employees, licensed and unlicensed, to various degrees to avoid noncompliance penalties that can include fines, damages, and exclusion from Medicare/Medicaid billing. It provides examples where lack of compliance oversight resulted in millions paid in penalties and kickbacks.
1 Human right fulfillment.pptx
This document discusses the concept of human rights in patient care. It provides 3 key points:
1) The concept of human rights in patient care provides a framework for addressing human rights abuses in health settings and holding governments accountable. It refers to applying general human rights principles to patient care contexts, protecting both patients and providers.
2) Human rights in patient care recognizes that patient and provider rights are interrelated. It focuses on non-discrimination and social inclusion.
3) Key human rights in patient care include patients' rights to liberty, privacy, information, bodily integrity, life, and providers' rights to decent working conditions, freedom of association, and due process. These rights are inherent and universal
HIPAA Privacy for Employers 101
This presentation reviews: what information must be protected, what policies and procedures need to be in place, what disclosures have to be given to employees, what agreements have to be in place for business associates, and what breach procedures have to be followed.
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Working with Regulators: A Focus on CMS | Took Kit: A Guide for Patient Adocates
The Affordable Care Act (ACA) is the tip of a very large, multi-faceted iceberg, one that is moving inexorably forward and will result in broad, deep changes in the way that health care in this country is understood and delivered. These changes are already exerting a significant impact on cancer research and care, and will continue to do so for the foreseeable future. This is also an era in which the patient voice and genuine, active patient participation have become integral to the process of developing and implementing biomedical research and health care policy.
That process is complex and multidimensional—but also well defined and transparent. The ability to influence the outcomes requires that an organization have a working knowledge of how the process works, which agencies are responsible and who makes the decisions. It is also critical to understand the ways in which electoral politics at both the national and state level impact health care policy. While that sounds straightforward, the regulatory process often can appear impenetrable to the organizations who seek to make their voices heard and influence the outcomes.
This Tool Kit is intended as a practical guide for patient advocacy organizations in their efforts to educate themselves about the regulatory process, develop appropriate staff expertise and responsibility for this area, and ultimately make a difference.
Joe Wall's Presentation
The document discusses President Obama's approval ratings, views on important issues facing the country like unemployment and healthcare, and polls on approval of the Affordable Care Act. It also contains information on the competitive races for US Senate in 2014, including breakdowns of seats held by Democrats and Republicans. In addition, there are statistics shown on the composition of Democratic and Republican districts.
James Rollins' Presentation
The document discusses Medicare's national coverage determination (NCD) process. It defines key terms like national coverage, reasonable and necessary criteria. The NCD process involves a request, benefit category determination, evidence review including technology assessments, a proposed determination with public comment, then a final determination. Evidence comes from medical literature, technology assessments, and an advisory committee. Coverage decisions can be national coverage, non-coverage, coverage with limitations, or contractor discretion. Reconsideration of an existing NCD requires new medical evidence or arguments that the original interpretation misrepresented evidence.
Jenny Gaffney Presentation
CMS uses both a national and local process to make coverage determinations for Medicare. The national coverage determination (NCD) process involves multiple opportunities for public comment and can result in coverage, coverage with restrictions, coverage with evidence development (CED), or non-coverage. Local coverage determinations (LCDs) are made by Medicare Administrative Contractors and can vary across jurisdictions. Engaging in both processes can help optimize coverage for new technologies.
An Insider's Guide to Working with CMS - Shari Ling
This document summarizes a presentation given by Shari Ling, Deputy Chief Medical Officer at CMS, to the Cancer Policy Institute at the Cancer Support Community. Some key points:
- CMS is focused on developing more patient-centered quality measures that assess outcomes important to patients and caregivers. They welcome input from patient advocacy groups.
- CMS aims to align quality measures across different healthcare settings to reduce reporting burden and focus measurement on the issues that matter most to patients.
- CMS is responsible for administering Medicare, Medicaid, and other large healthcare programs, and uses quality measurement to incentivize higher quality, more coordinated care, and payment reform efforts like value-based purchasing.
Working with Regulators: A Focus on CMS | June 24, 2014 | All Slides
CMS is seeking input from patient advocacy groups like the Cancer Support Community on developing quality measures that focus on issues that matter most to patients and caregivers. CMS measures quality of cancer care across different settings and aims to align measures across public and private payers to reduce reporting burden and consistently focus on important patient issues. CMS oversees large healthcare programs that impact over 100 million Americans and seeks to transform the healthcare system to make it more patient-centered, outcomes-focused, coordinated, and sustainable.
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- 1. www.CancerSupportCommunity.org Uniting The Wellness Community and Gilda’s Club Worldwide Working with Regulators: A Focus on CMS An Educational Program of the Cancer Policy Institute at the Cancer Support Community in Partnership with Uniting a Community (UaC): Policy, Advocacy, Education and Action Network
- 2. Conditions of Participation Clinical Standards Group ----- Center for Clinical Standards & Quality
- 3. What are Conditions of Participation? Conditions of Participation (CoPs) and Conditions for Coverage (CfCs) are health and safety regulations which must be met by Medicare and Medicaid-participating providers and suppliers. They serve to protect all individuals receiving services from those organizations. 3INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
- 4. What are Conditions of Participation? The CoPs help CMS ensure that all providers and suppliers participating in the Medicare and Medicaid programs provide high quality care, and work towards continued quality improvement. 4INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
- 5. Health Care Organizations & Provider Types CMS has CoPs or CfCs for the following health care organizations and provider types: • Ambulatory Surgical Centers • Community Mental Health Centers • Comprehensive Outpatient Rehabilitation Facilities • Critical Access Hospitals • End-Stage Renal Disease Facilities • Federally Qualified Health Centers • Home Health Agencies • Hospices • Hospitals 5INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
- 6. Health Care Organizations & Provider Types • Hospital Swing Beds • Intermediate Care Facilities for the Intellectually Disabled • Long Term Care Facilities • Organ Procurement Organizations • Portable X-Ray Suppliers • Providers of Outpatient Services (physical and occupational therapists in independent practice, outpatient physical therapy, occupational therapy, and speech pathology services) • Religious Nonmedical Health Care Institutions • Rural Health Clinics • Transplant Centers 6INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
- 7. Revisions to the CoPs Revisions are made to the CoPs in response to: • Statutory Changes • Administration Policies and Priorities • National Issues and Events • Changes in Medical Practice 7INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
- 8. Examples of Current Priority Issues in CoPs • Reduce Healthcare Acquired Conditions • Reduce avoidable hospital readmissions • Reduce burden on providers • Antibiotic Stewardship 8INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
- 9. www.CancerSupportCommunity.org Uniting The Wellness Community and Gilda’s Club Worldwide 9 Working with Regulators: A Focus on CMS was made possible thanks to the support of GlaxoSmithKline