U.S. health law and policy 2001 : a guide to the current literature / Donald H. Caldwell, Jr.

Format:

Book

Author/Creator:

Caldwell, Donald H. (Donald Harrison), 1959-

Series:

Jossey-Bass/AHA Press series

Language:

English

Subjects (All):

Medical care--Law and legislation--United States--Bibliography.

Medical care.

Medical laws and legislation--United States--Bibliography.

Medical laws and legislation.

Medical policy--United States--Bibliography.

Medical policy.

Medical care--Law and legislation.

United States.

Genre:

Bibliographies.

Physical Description:

xxi, 593 pages ; 29 cm.

Edition:

First edition.

Other Title:

US health law and policy 2001

United States health law and policy 2001

Place of Publication:

San Francisco : Jossey-Bass ; Chicago : Health Forum, Inc. : AHA Press, [2001]

Contents:

Part 1 Medical Facilities and Organizations

Chapter 1 An Overview of Health Law 3

Chapter 2 Health Care Facilities and Settings 13

2.01 In General 13

2.02 Hospitals 16

(1) In General 16

(2) Rural Hospitals 23

(3) Academic Medical Centers 24

(4) Religious Medical Institutions 26

2.03 Nursing Homes 27

2.04 Medical Offices 37

2.05 Home Health Care 38

2.06 Assisted Living Facilities 41

2.07 Hospices 41

Chapter 3 Managed Care Organizations 43

3.01 The Health Maintenance Organization (HMO) Model of Care 46

3.02 HMO Model Types 51

3.03 State Regulation of HMOs 53

3.04 Point-of-Service (POS) Product Regulation 55

3.05 Other State Laws 55

(1) State Insurance Laws 56

(2) Coordination of Benefits 56

(3) Certificate-of-Need Laws 56

(4) State Rate-Setting Laws 56

(5) Any-Willing-Provider Laws 56

(6) Small-Group Insurance Reform 56

3.06 Federal Qualification 57

3.07 Government Reimbursement Programs 57

(1) Products for Medicare Beneficiaries 57

(2) Medicaid Contracting 59

(3) The Federal Employees Health Benefit Program (FEHBP) 60

(4) State Government 60

3.08 HMO Management and Operational Issues 60

(1) Internal Organization and Controls 60

(2) Employer Agreements 62

(3) Provider Relationships 62

(a) Provider Credentialing 62

(b) Provider Contracts

Compensation Arrangements 63

(c) Provider Contracts

Nonrate Issues 64

(d) HMO Liability for Provider Malpractice 65

(e) Rate Setting and Financial Strategy 65

3.09 Mergers and Closures 66

3.10 HMO Grievance Procedures 66

3.11 Preferred Provider Organizations (PPOs) 68

Chapter 4 Integrated Delivery Systems 69

4.02 Advantages and Disadvantages of Integration 86

(1) Potential Barriers to Integration 86

(2) Financial Issues 86

(3) Structure and Degree of Integration 87

4.03 Common Legal Issues 88

4.04 Particular Network Issues 90

(1) Acquisition of Physician Practices 91

(2) Types of Acquisition 93

(3) Structuring Payment 94

(4) The Management Service Organization (MSO) Model 95

(5) The Physician Hospital Organization (PHO) 95

(6) Foundation Models 97

(7) Capitation Issues 97

(8) Medical Practice Mergers 98

(9) Rural Hospital Networks 99

(10) Freestanding Outpatient Facilities and Services 100

(11) Joint Ventures 101

(12) Unwinding Deals 102

Chapter 5 Utilization Review 105

5.02 Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) 110

Part 2 Regulatory Matters

Chapter 6 Tax Issues 115

6.01 The Section 501(c) Exempt Institution: Qualifying for and Maintaining the Exemption 115

(1) The 501(c) Exemption: Advantages and Disadvantages 118

(2) Charitable Purpose Defined 121

(b) Charitable Hospitals 122

(c) Charitable Nursing Homes 125

(d) Charitable Professional Standards Review Organizations 125

(e) Charitable Share Service Organizations 125

(f) Individual Practice Associations 125

(g) Faculty Group Practice Plans 126

(h) Integrated Delivery Systems 126

(i) Physician Hospital Organizations 126

(j) Other Charitable Organizations 127

(k) Intermediate Sanctions 127

6.02 Unrelated Business Income Tax (UBIT) 129

6.03 Application of Federal Tax Laws to Corporate Restructuring and Joint Venturing 130

6.04 State and Local Taxes 133

6.05 Tax-Exempt Financing 134

6.06 Taxation of Health Benefits 135

6.07 Audit Issues 135

6.08 For-Profit Conversion Issues 137

Chapter 7 Antitrust Issues 143

7.01 General Application of Antitrust Principles to Health Care 143

7.02 Antitrust Issues Raised by Provider Activities 149

7.03 Merger and Joint Venture Developments 153

7.04 Antitrust Implications of Integrated Delivery Systems 160

7.05 Government Enforcement Activities 164

Chapter 8 Provider Reimbursement Issues 169

8.02 Medicare 175

(2) Part A: Inpatient Services Related to Acute Hospital Inpatient Care 179

(a) Diagnosis-Related Groups 179

(b) Special Payment Rules for Certain Costs 180

(3) Part B: Outpatient and Physician Services 182

(4) Medicare+Choice Program 183

(5) Home Health Care 186

8.03 Medicaid 187

(1) General Framework 187

(2) Reimbursement Principles 190

(3) Recent Reforms 191

8.04 Reimbursement Review Activities: Peer Review Organizations 200

8.05 Fraud and Abuse Statutes: Proscribed Conduct 200

(1) False Statements or Claims 203

(2) Illegal Remuneration (Stark I and II) 214

(3) Other Illegal Acts 218

8.06 Civil Monetary Penalties Law 221

(1) Proscribed Conduct 221

(2) Civil Monetary Act Procedures 222

8.07 Audits 222

8.08 Private Insurance 223

Chapter 9 Bankruptcy and Insolvency 227

9.02 Hospitals 230

9.03 Managed Care Organizations 230

Chapter 10 Health Care Planning 233

10.01 The National Health Planning Act 234

10.02 Planning Activities 235

Chapter 11 Regulation of Private Health Care Financing 239

11.01 Regulation of Private Insurance 240

11.02 The Employee Retirement Income Security Act of 1974 (ERISA) 243

11.03 Regulation of Managed Care 249

Part 3 Licensure, Liability, and Labor Issues

Chapter 12 Licensure of Health Care Professionals 253

12.01 Physicians 255

12.02 Nurses 256

12.03 Physician Assistants 258

Chapter 13 Professional Relationships in the Health Care Enterprise 261

13.01 Medical Staff Issues 262

13.02 Quality 264

13.03 Professional Peer Review 267

13.04 Physician Deselection 270

Chapter 14 Labor Issues 273

14.02 Physician Unionization 276

Chapter 15 Liability of Health Care Professionals 279

15.01 Liability for Patient Injury 279

15.02 Obligation to Obtain a Patient's Informed Consent 294

15.03 Obligation to Report Abuse 299

Chapter 16 Liability of Health Care Institutions 301

Chapter 17 Liability of Managed Care Organizations 311

17.02 Tort Liability 316

17.03 Liability for Provider Exclusion 321

Chapter 18 Obligations to Provide Medical Care and Access 323

18.02 Emergency Medical Treatment and Active Labor Act (EMTALA) 328

18.03 Obligations to Provide Care Under State Law 332

18.04 Obligations under the Hill-Burton Act 333

18.05 Nondiscrimination Obligations Under Title VI of the Civil Rights Act of 1964 334

18.06 Discrimination Against Persons Based on Medical Condition 335

18.07 Financial Criteria 335

(1) Denial of Nonemergency Treatment for Financial Reasons 335

(2) Termination of Nonemergency Treatment for Financial Reasons 336

18.08 Grievance and Appeal Procedures 336

18.09 Health Insurance Portability and Accountability Act of 1996 (HIPAA or Kennedy-Kassebaum) 337

18.10 Balanced Budget Act of 1997 (BBA) 339

Chapter 19 AIDS Issues 343

19.02 Legal Issues Relating to Treatment of Patients with AIDS or HIV Infection 352

(1) Duty to Treat 352

(2) HIV Testing of Patients 353

(3) Duty to Provide a Safe Workplace 355

(4) Privacy 355

19.03 Issues Relating to Health Care Professionals with AIDS or HIV Infection 358

(1) Risk of Transmission 358

(2) Employment Laws: Legal Protections for Employees with HIV 359

(a) Prohibition Based on Handicap 359

(b) General Duty of Employer to Deal Fairly 359

(c) Other Sources of Employment Rights 360

Chapter 20 Environmental Concerns Affecting Health Care Facilities 363

20.02 Waste 366

(2) Regulated Medical Waste 366

(b) Regulating Agencies 367

(c) Medical Waste Tracking Act 368

(d) Segregation, Packaging, and Labeling of Medical Waste 368

(e) Disposal Techniques 368

(i) Incineration 369

(ii) Autoclaving 370

(iii) Landfilling 370

(iv) Microwaving, Irradiation, and Chemical Disinfection 370

20.03 Emergency Planning and Community Right-to-Know Act (EPCRA) 370

Chapter 21 Medical Records and Privacy Issues 373

21.02 Privacy Issues 378

21.03 Information Garnered from

Genetic Testing 385

21.04 Telemedicine 396

Chapter 22 Health Care Reform 401

Appendix A Health Law Periodicals, Digests, and Newsletters 421

Appendix B Reference Sources and Government Serials 455

Appendix C Computer Databases and Internet Sites 457

Appendix D State-by-State Synopsis of Selected Statutes of Limitation Laws 471

Appendix E Table of Acronyms and Abbreviations 473

Appendix G Relevant Federal Agencies 513

Appendix H Selected Nongovernmental Agencies 523

Appendix I State Laws Governing Medical Records 533

Appendix J Health Care Financing Administration Regional Offices 547.

Notes:

Includes indexes.

ISBN:

0787955043

OCLC:

45621036