Understanding HIPAA and PPACA- Essential Legal and Ethical Training for Healthcare Staff

Understanding HIPAA and PPACA- Essential Legal and Ethical Training for Healthcare Staff

Introduction

All the staff members of every facility must always be familiar with legal and ethical issues surrounding HIPAA and PPACA. These two acts are crucial in the delivery of proper treatment care for all patients. They must be observed all the time, and each client must be treated with the best services available. Health Insurance Portability and Accountability Act (HIPAA) requires every employee to have an insurance cover that is valid even if they are no longer employed. It will enable them to receive proper and essential medical services all the time. Patient Protection and Affordable Care Act (PPACA) requires employers to cover medical expenses for their employees.

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HIPAA

Health Insurance Portability and Accountability Act (HIPAA) was put into law in 1996. The motion was passed by the United States federal statute enacted by the 104^th United States Congress. The proposal was signed on August 21, 1996, by President Bill Clinton (Moore & Frye, 2019). The Act was created to enhance proper accountability and portability of health insurance covering employees between jobs. Over the past 20 years, many changes have been made to the Act to improve its efficiency and accountability. Different introductions such as privacy rule, security rule, Breach notification rule, and final omnibus rule were all included in the Act. On April 14, 2003, the privacy rule was introduced, while the security rule was introduced on April 21, 2005. In September 2006, the Breach notification rule became effective, and lastly, the final Omnibus rule was included in March 2013.

HIPAA Act had major intentions for the patient’s care and management system. Protection of health care coverage for all individuals who lose or change their jobs. The Act allowed the workers to continue receiving their medical needs even if they lost their jobs. Another intention of the Act was to standardize all healthcare transactions. This brought accountability and transparency in the management of health finances (Moore & Frye, 2019). It also prevented the waste, fraud, and abuse of health care insurance, allowing for proper service delivery. It also had intentions of promoting the usage of medical savings through the introduction of tax breaks. These reforms increase the number of individuals attending medical services, reducing the morbidity of many diseases.

Major provisions of this Act included portability, patients’ information safety, and simplicity in administration. In portability, there are provisions of available and renewable health insurance while eliminating the previous condition clause. This is beneficial to all individuals changing jobs and health plans (Moore & Frye, 2019). Patients’ information is also given a huge priority in this Act. All patients’ information is confidential and not available to unauthorized staff. Information such as the patient’s name, condition, social security number, etc., are all considered confidential and private. The administration process is made easier due to the existence of transparent transactions and confidentiality among health staff.

HIPAA Act has a huge impact on patient care. The major purpose of the Act is to provide quality, safe, transparent, and confidential care for all patients. In this Act, all patients have more control over matters concerning their health (Moore & Frye, 2019). The patients have the right to access their medical treatment in any hospital of choice, provided health insurance is valid. The confidentiality championed by the Act allows the patients to share more details about themselves with physicians. This promotes a complete understanding of each one’s condition, and an appropriate solution is provided.

The PPACA is an acronym for the Patient Protection and Affordable Care Act. It is one of the two bills that constitute the healthcare reform bill. By March 2010, the bill was signed to become a law by the then-elected president, Barack Obama, which gave it the other name, “Obamacare.” While he was campaigning for his presidency, Obama had promised that one of his sole aims was to reform the healthcare system- where close to 50 million people had no health insurance coverage (Mary, 2019). This implied that when the bill was implemented, it would down uninsured Americans by a value greater than half.

There were three major goals of this law when it was being signed. Increase the number of individuals who have access to inexpensive health insurance (Patel, 2021). The law offers incentives (known as “premium tax credits”) to customers with earnings ranging from 100 percent to 400 percent of the federal poverty line (FPL). Extend Medicaid to include all people earning less than 138 percent of the federal poverty level. Finally, it was created to encourage new medical care delivery systems that would reduce overall healthcare expenditures. All these goals pointed at ensuring many people in the United States had health insurance coverage. They enhanced the quality of healthcare delivery, which was not incorporated into the Medicare of 1965.

According to (Patel, 2021), some of the law provisions took effect in 2010, while others had to wait a little longer before taking root in the system. Those that were effective immediately include provisions like the coverage by the new and existing health plans of all dependent children of a policyholder within the first six months of signing the bill. The provision was to apply as long as the dependent child was aged below 26 years old. Moreover, the shortfall in the Medicare program for prescription medicines, known as the “doughnut hole,” would start to close in 2010 and be completely closed by 2020. Medicare users who fell into the gap in 2010 were given a $250 reimbursement, and future reductions on brand-name medications were guaranteed. Another major provision required that private insurance programs offer minimum packages of benefits under the federal government’s determination. Finally, it provided that no child or anyone would be denied coverage based on a preexisting condition.

Analysis

All the staff must be informed and be familiar with all the requirements of the two acts. All the staff are expected to be ethical and ensure the confidentiality of the facility information. Through the learning of the two acts, they will appreciate the role of confidentiality within the facility. They are also informed to know how the facility will take care of them in times of emergencies. In PPACA, the facility covers a certain percentage of employees’ medical needs. By learning and teaching them these policies, these employees will know the criteria for being beneficiaries. Learning these terms will also help in retrieving information about each patient on time.

Conclusion

These two acts are crucial and necessary for both the health caregivers and the patients. They provide the patients with relief at times of difficulty by providing the required medical attention. The HIPAA ensures the patient’s information is private and confidential. This builds confidence in patients promoting healthy and professional interaction with the staff. Therefore, all facility staff must know these acts as well as the patients themselves.

References

Moore, W., & Frye, S. (2019). Review of HIPAA, part 1: history, protected health information, and privacy and security rules. Journal of Nuclear Medicine Technology, 47(4), 269-272.

Mary, T. M., & Kang, J. A. (2019). The Perfect Communication Storm: News Coverage of the Patient Protection Affordable Care Act. Open Journal of Political Science, 9(02), 299.

Patel, K. K. (2021). Patient Protections in the Affordable Care Act. In The Affordable Care Act as a National Experiment (pp. 15-21). Springer, Cham.

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As the new office coordinator of a small multi-specialty group practice, you are responsible for training all newly hired employees and in-service training for current staff. You are informed that not all staff members know the legal, ethical, and regulatory implications of HIPAA and PPACA. You are asked to put together a training seminar on this topic that includes the following:
Introduction

Discuss and define HIPAA; including its
Background/History
Intent
Major Provisions
Implications on Patient Care
Discuss and define PPACA; including its
Background/History
Intent
Major Provisions
Implications on Patient Care
Analysis of why staff must be informed of these topics
Conclusion
Write a 3-5 page paper or create 8-10 PowerPoint slides, not including a title slide and reference slide, with 150-300 words of speaker notes. Cite at least 2 scholarly references published within the last 5 years and use APA style.