Outline the insurance market rules and rating factors and how HIPAA impacts the rating factors
Description
Three discussion questions please use APA formatting for citations. 1-2 paragraphs for each question.
1. Outline the insurance market rules and rating factors and how HIPAA impacts the rating factors.
2. Discuss the federal agencies that are responsible for the oversight of HMOs, and discuss when federal regulations or state regulations would apply to situations, such as HIPAA privacy standards.
3. “And, lastly the Financial Stability Oversight Council (Small, 2017).” An extremely important piece of legislation. The Affordable Care Act also created the agency charged with overseeing the insurance industry. Weve referenced the Center for Consumer Information and Insurance Oversight (CCIIO) in previous discussions during our course. The Center is part of the Centers for Medicare & Medicaid for Consumer Information and Insurance Oversight: The Center for Consumer Information and Insurance Oversight is charged with helping implement many provisions of the Affordable Care Act Medicaid Services.
Take a look at the website http://healthcoverageguide.org/reference-guide/laws-and-rights/regulatory-agencies/ (Links to an external site.) and identify the legislation that established financial oversight. Looking back, has the legislation had the impact on healthcare that was intended?
4. Do some quick research on St. Vincents Hospital of New York City. The third oldest hospital in New York opened in 1849 and closed in 2010 primarily due to a low payer mix (too many indigent/uninsured patients). Simply put, if we can provide insurance to everyone; that should improve the payer mix for all healthcare organizations and curb cost shifting (inflation). It would also lower the risk profile of the U.S. patient population by providing preventative care instead of more expensive hospital admissions and surgeries. What can we do differently to prevent hospitals from closing; especially one that remained opened for just over 160 years and served those with the inability to pay.
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