Major Legislation
This landmark 1965 legislation established Medicare and Medicaid.
What is the Social Security Act Amendments of 1965?
This federal program provides health insurance to individuals aged 65 and older, as well as certain younger individuals with disabilities.
What is Medicare?
This 1997 program expanded health coverage to children in low-income families.
What is the State Children's Health Insurance Program (SCHIP)?
This term refers to the official name of the organization that accredits and certifies healthcare organizations in the U.S. to ensure they meet established performance standards.
What is The Joint Commission?
This term refers to a system used to classify hospital cases into groups that are expected to have similar hospital resource use.
What is Diagnosis-Related Groups (DRGs)?
This 2010 Act aimed to reduce the number of uninsured Americans and implement significant health insurance reforms.
What is the Affordable Care Act (ACA)?
This state-based program offers health insurance coverage to low-income individuals and families, often with eligibility requirements that vary by state.
What is Medicaid?
This 2013 rule under the ACA includes provisions for preventive care services with no cost-sharing, affecting the scope of services nurses can provide.
What is the Preventive Services Mandate?
This type of survey conducted by the Joint Commission is an evaluation of an organization’s compliance with its standards, typically done every 3 years.
What is an Accreditation Survey?
This is the primary goal of the DRG system, which aims to provide a means for hospitals to receive fixed payments based on the DRG.
What is Cost Control or Payment Standardization?
Passed in 1996, this act aimed to protect patient privacy and electronic health information.
What is the Health Insurance Portability and Accountability Act (HIPAA)?
This type of private insurance is often obtained through an employer and can be either individual or family coverage.
What is Employer-Sponsored Insurance?
This program, started in 1965, provides health services to American Indian and Alaska Native populations.
What is the Indian Health Service (IHS)?
The Joint Commission’s “NPSGs” are designed to improve patient safety and focus on high-risk areas. What does “NPSG” stand for?
What are National Patient Safety Goals?
This term describes a situation where a hospital’s DRG payment is reduced due to a patient’s readmission within a certain period, intended to discourage unnecessary readmissions.
What is the Readmission Penalty?
This 1983 policy introduced the Diagnosis-Related Group (DRG) system to control hospital costs.
What is the Medicare Catastrophic Coverage Act?
This program, part of the Affordable Care Act, provides subsidies to help individuals and families purchase health insurance through state or federal exchanges.
What is the Health Insurance Marketplace?
The implementation of this policy in 1990 improved accessibility for individuals with disabilities.
What is the Americans with Disabilities Act (ADA)?
This process, required by the Joint Commission, involves assessing and improving the effectiveness of patient care and organizational processes through data collection and analysis.
What is Performance Improvement or Continuous Quality Improvement (CQI)?
The DRG payment system categorizes cases based on the principal diagnosis, the type of treatment, and this additional factor, which adjusts payments based on the severity of the patient's condition.
What is Case Complexity or Severity of Illness?
This act, passed in 2003, authorized the implementation of a national standard for electronic health records, impacting how nurses document patient care.
What is the Health Information Technology for Economic and Clinical Health (HITECH) Act?
This government program provides health insurance for active-duty military personnel and their families, as well as veterans.
What is TRICARE?
This 2017 act allows for the expansion of nurse practitioners' scope of practice in many states by removing restrictions on their ability to practice independently.
What is the National Council of State Boards of Nursing (NCSBN) Model Nursing Practice Act?
The Joint Commission requires hospitals to have a formal program for this activity, which involves identifying and analyzing potential safety risks and errors in patient care.
What is Risk Management?
This organization updates the DRG classifications and weights annually, based on hospital data and changes in clinical practice.
What is the Centers for Medicare & Medicaid Services (CMS)?