Health Law
The health care industry is currently the largest sector of the U.S. economy, and arguably, the most heavily regulated. Health law is a burgeoning specialty area, which primarily focuses on regulatory and policy issues facing health care providers such as hospitals, treatment centers, clinics, doctors, and pharmaceutical companies. However, due to its complexity, health law intersects and overlaps with many other areas of law including medical malpractice, personal injury, and insurance law.
Medical Record Privacy
There are many regulations in place to ensure that health care providers take adequate care regarding patients' privacy, record retention, and confidentiality. In 1996, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) was enacted. HIPPA was enacted to make transmitting health care information electronically, more efficient for health care providers.
In response to privacy concerns, the Department of Health and Human Services (HHS) developed privacy standards and enacted the Privacy Rule, in 2001. The Privacy Rule sets out procedures regarding storing and retaining documents, informing patients of the health care providers' procedures, and the patients' rights. The information protected by the Privacy Rule is any information received by a health care provider, which is individually identifiable information relating to the health care (mental or physical) of an individual. This information is often referred to as Protected Health Information (PHI).
In summary, HIPPA, in conjunction with the Privacy Rule, prohibits discrimination of individual participants and beneficiaries based on health status, sets standards for privacy of medical records, requires specific information to be communicated to patients regarding their privacy, and to reduce administrative costs of providing and paying for healthcare. HIPPA governs a wide range of entities including employer-sponsored group insurance plans, insurance companies, and managed care organizations (MCO).
Health Care Planning
Living wills (also known as advanced directives) and durable powers of attorney are legal documents that can assist your family members and health care provider make decisions for you, in the event you are unable.
Living wills appoint a person to make decisions for another should they become incompetent or unable to make decisions for themselves. Living wills provide specific instructions to the decision maker and can address issues such as end-of-life decisions, specific definitions of acceptable quality of life, disposition of the body (cremation vs. burial), and organ donation.
Durable powers of attorney give the named agent power to make medical and health care decisions for a person. However, a durable power of attorney does not include specific instructions for care or end-of-life decisions. Because specific instructions and wishes are not included, it is important to discuss these issues with the person to whom you give power of attorney.
Health Care Insurance Plans
Employer-sponsored group insurance plans are common and often confusing. If there are multiple plans offered, the choices may seem overwhelming. When selecting health insurance (whether it is an employer-sponsored program or an individual policy) it is important to understand costs and benefits of different types of plans. For example, selecting a Preferred Provider Organization plan (PPO) may be attractive due to its lower cost. However, PPOs offer the lower prices for participating providers, meaning if you wish to visit a medical professional who is outside of the network, there will be out-of-pocket expense for the services. On the other hand, Health Maintenance Organizations (HMO) may provide more choices, but at a higher cost. It is important to remember that each insurance coverage plan is different, and when selecting coverage you should review the plans carefully and select one that fits your individual needs.
Medicare
Medicare is federal program, which provides health care coverage for people who are over the age of 65 or who are disabled. Medicare may be used for doctor or clinic visits as well as for long-term medical treatment and rehabilitation. Medicare coverage can also used for assisted-living facilities including nursing homes. Not all health care providers accept Medicare, and it is necessary to ensure coverage that a patient using Medicare verify before treatment.
Medicaid
Medicaid is a federal program, which works in conjunction with state programs to provide medical insurance assistance to low-income people, in particular, children. Much like Medicare, not all health care providers accept Medicaid as a form of payment or insurance coverage, and it is necessary to verify that Medicaid will be accepted before receiving treatment. In some states, the Medicaid programs have been expanded to include the State Children's Health Insurance Program (SCHIP). This program was established specifically to provide health care to uninsured and low-income children. In states where it is not included under an expanded state Medicaid program, it is often offered through a separate program.
Health law is complex and far-reaching involving HIPPA compliance and compliance with other state and federal health regulations. If you have questions regarding qualifying for Medicaid or Medicare, the manner in which your health care provider handled your Protected Health Information or any other HIPPA compliance issue, an experienced health law attorney can provide guidance.
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