Regulatory_Bod_Paer

Regulatory Body Paper HCS/578 October 24, 2011 Regulatory Body Paper Health Professionals are regulated and licensed by regulatory bodies as required by local legislation. All nurses are required to be licensed to practice with their designated provincial nursing regulatory body. In nursing practice, legal responsibility is increasing significantly as each year go by. Nurses must understand the importance of knowing his or her legal boundaries in order to ensure competent and safe nursing care. The subject of the matter will discuss the regulatory bodies, their functions, their emphasis, and their impact on health care. The Joint Commission (TJC) and The Center for Medicare and Medicaid Services (CMS) will also be examining. Regulatory Bodies Nursing regulatory bodies also known as colleges or associations, are responsible for the licensing of nurses within their respective zone area. The nursing regulatory bodies receive their authority from legislation. The array of regulations that govern health care can seem overwhelming to people who work in the industry. “Almost every aspect of the field is overseen by one regulatory body or another, and sometimes by several. Health care professionals may feel that they spend more time complying with rules that direct their work than actually doing the work itself” (Field, 2007). The regulatory bodies consist of the government, federal, state, local, and large groups of confidential organizations The regulatory body’s duty is to guaranteeing protection to the safety of the public and of the operating staff in the health care entity. The all-encompassing nature of health care regulation comes from the basic worry that is at risk. Most watchers recognize that some form of supervision is considered necessary when matters concerning life and health are in jeopardy. These different divisions of power create a foundation of continuous pressure in health care administration since the implementation of regulatory bodies. The different divisions is a process of “checks and balances” to make certain that no level will become too powerful, and make sure each receive input from one another. Their Functions The United States government plays a large role in the financing, organizing, overseeing and in some instances even delivery of health care the federal government’s role in financing and delivering care; lowering the rate of growth in Medicare spending; and advance-care planning for serious illness. The overall responsibility is to govern over the people and over levels of government. The federal government has regulated health matters by virtue of two powers granted to the federal government in the federal constitution. The first is the power to directly regulate commerce between the states. This allows the federal administration to control transactions that cross state boundaries, such as airlines, railroads, and the manufacture and sale of goods that are sold in more than one state, like pharmaceutical drugs and medical devices. The second federal power is the authority to spend money for the general welfare of the people of the United States. According to Health Affairs (2011) The state has traditionally had jurisdiction over physicians, nurses, and other health care professionals, as well as hospitals and clinics, and sanitation, disease surveillance, food safety and other general health matters. State and local government are: traditional public health, including health monitoring, sanitation, and disease control; the financing and delivery of personal health services including Medicaid, mental health, and direct delivery through public hospitals and health departments; environmental protection, including protection against man-made environmental and occupational hazards; and the regulation of the providers of medical care through certificate-of need and state rate setting as well as licensing and other functions. Their Emphasis As a health care company, our operations and relationships with health care providers such as hospitals, other healthcare facilities, and health care professionals are subject to extensive and increasing regulation by numerous federal, state, and local government entities. These laws and regulations often are interpreted broadly and enforced aggressively by multiple government agencies, and various state authorities. Imposition of sanctions associated with a violation of any of these health care laws and regulations could have a material adverse effect on business, financial condition and results of operations. Changes in health care legislation or government regulation may restrict existing operations, limit the expansion of business or impose additional compliance requirements and costs, any of which could have a material adverse affect on organization, financial condition and results of operations. Operations and relationships with health care providers such as hospitals, other health care facilities, and health care professionals are subject to extensive and increasing regulation by numerous federal, state, and local government entities. “These laws and regulations often are interpreted broadly and enforced aggressively by multiple government agencies. Government audits, investigations and prosecutions, even if anyone found to be without fault, can be costly and disruptive to an organization” (Law, 2009). Their Impact on Health Care While policy and decision making moves, the rapport between doctor/patient have focused on the quality of care. With respect to how quality may be affected by staffing, the Institute of Medicine recently completed a comprehensive study of the adequacy of nursing staff in hospitals and nursing homes (Davis, Frank, & Wunderlich, 1996). Specifically, concerns were raised about the paucity of professional nurses employed in nursing homes and the likelihood that professional nurses in inpatient hospitals "may be called upon increasingly to fill roles that require increased professional judgment, management of complex systems that span the traditional boundaries of service settings, and greater clinical autonomy" (Davis, Frank, & Wunderlich, 1996). To improve methods of meeting patients need, the structural change should be modified to meet the appropriate level and staffing. The Joint Commission “The Joint Commission is an independent, not-for-profit group in the United States that administers accreditation programs for hospitals and other healthcare-related organizations” (Joint Commission, 2011). The Commission performance standard purpose is to deal with critical essentials of operation, such as patient care, medication protection, and disease control and customer rights. The majority the state governments entail that health care organizations be accredited by the Joint Commission as a requirement for licensing and Medicaid reimbursement. Joint Commission standards are the core purpose of the appraisal process that will assist health care organizations measure, assess and improve performance. The standards center of attention is the importance of patient, individual, or resident care and organization functions that are essential to providing safe, high quality care. The Joint Commission’s up-to-date standards set expectation for health care performance that is logical, attainable and reviewable. “Joint Commission standards are developed with input from health care professionals, providers, subject matter experts, consumers, government agencies (including the Centers for Medicare & Medicaid Services) and employers” (Joint Commission, 2011). To continue and receive accreditation, health care organizations go through an extensive on-site evaluation by the Joint Commission experts such as managers, physicians, and nurses about once every three years. The intention of the review is to appraise employee performance in areas that involves patient care. The Joint Commission will personally visit patients and health care workers in which the hospitals evaluation outcome is scored. Depending on the organization appraisal results, accreditation is awarded. Because Joint Commission standards is viewed as the most rigorous in the health care industry, hospitals are held to the upmost and as a result, they are dedicated to providing the highest level care to their customers. The Center for Medicare and Medicaid Services The Centers for Medicare and Medicaid Services (CMS) “is the federal body responsible for administering Medicare and Medicaid programs. CMS also runs the State Children’s Health Insurance Program (SCHIP), which is jointly financed by the Federal and State governments and administered by individual States” (CMS, 2011). Only certain low-income citizens and families who meet the federal and state law eligibility guideline are qualified for Medicaid. People who are eligible will not receive money; instead, Medicaid will pay his or her medical bill directly to their health care provider. A small out-of-pocket (co-pay) for various medical services maybe required depending the state's rules. “Medicare is a health insurance program set in place for people age 65 or older, people under age 65 with certain disabilities, and people of all ages with permanent kidney failure requiring dialysis or a kidney transplant” (CMS, 2011). Medicare has: Part A Hospital Insurance – Because the workforce or their spouse has paid for Part A (Hospital Insurance) through his or her payroll taxes while working, the majority of consumers do not have to pay a premium. Medicare Part A elevates some expenses by assisting with a number of coverage with inpatient care in health care facility, as well as vital hospitals admission, and skilled nursing services. Part B Medical Insurance - Most people pay a monthly premium for Part B. Medicare Part B (Medical Insurance) picks up some expenses Part A do not cover. Part B helps with covering doctors' service and outpatient care. When medically necessary, Part B also helps pay for covered services and supplies. Starting January 1, 2006, most people will pay a monthly premium for Prescription Drug Coverage. Consumer’s who has Medicare are eligible for drug coverage. “Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later” (CMS, 2011). Conclusion A regulatory body is governing by the federal, state, local, and large private groups. These bodies oversee one another. The regulatory bodies have a legal responsibility to protect the safety of the public and the staff of the health care organization. Their function, emphasis, and impact on health care are all vital to the consumers. New standards are added only if they relate to patient safety or quality of care, have a positive impact on health outcomes, meet or surpass law and regulation, and can be accurately and readily measured. References: Center for Medicare and Medicaid Services 2011, http://www.allgov.com/agency/Centers_for_Medicare__Medicaid_Services__CMS_ Davis, Carolyn K., Sloan, Frank A., and Wunderlich, Gooloo S., (1996). Nursing Staff in Hospitals and Nursing Homes: Is it Adequate' Institute of Medicine. Washington, DC: National Academy of Sciences. Field, Robert I., (2007). Health Care Regulation in America. New York https://www.cms.gov/MedicaidGenInfo/ Significant Federal and State Healthcare Laws Governing Our Business 2009 http://www.wikinvest.com/stock/CurrencyShares_British_Pound_Sterling_Trust_ETF_(FXB)/Significant_Federal_State_Healthcare_Laws_Governing_Business The role of state and local government in health Affairs, 2011 p. 9 http://content.healthaffairs.org/content/2/4/1.full.pdf Wallechinsky, David, 2009 AllGov.com.