Experience with Federal Health Care Statutes, as Listed in Federal Register

  • IPPS legislation is contained in § 4432 of the Balanced Budget Act of 1997
  • Deficit Reduction Act of 2005  provisions related to TPL and coordination of benefits for Medicaid beneficiaries (42 CFR §433.13)
  • Health Insurance Portability and Accountability Act (HIPAA Privacy Rule 45 CFR Part 160 and Subparts A and E of Part 164 and HIPAA Security Rule 45 CFR Part 160 and Subparts A and C of Part 164)
  • Section 1886(d) of the Social Security Act which sets forth a system of payment for the operating costs of acute care hospital inpatient stays under Medicare Part A (Hospital Insurance) based on prospectively set rates. This payment system is referred to as the inpatient prospective payment system (IPPS) or shortened to the Prospective Payment System (PPS) and uses DRGs as well as Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA)  / 42 CFR §412.60 – DRG classification and weighting factors
  • 45 CFR §164.308 (subsections) – Administrative, Physical and Technical Safeguards, HIPAA Covered Entities
  • 45 CFR §164.410 (subsections) – Notification by a Business Associate
  • 45 CFR §164.502 (subsections) – Uses and disclosures of Protected Health Information (PHI)
  • 45 CFR §164.410 (subsections) – PHI Breach Notification by Business Associate
  • Meaningful Use Provisions certification criteria including § 170.304-§ 170.314
  • 45 CFR §162.1002 (subsections) – Medical Code Sets, including ICD-10
  • Meaningful Use provisions of the American Recovery and Reinvestment Act of 2009 (ARRA) specifically the Health Information Technology for Economic and Clinical Health including security risk analysis (HITECH Act 45 CFR §164.308(a)(1))
  • 42 CFR §412.2(c)(5)  subsection (d) hospitals, 413.40(c)(2) for non-subsection (d) hospitals, and 412.540 for long term care hospitals – three day payment window. 
  • Affordable Care Act, HR 3590 passed December 2009, Patient Protection and Affordable Care Act prohibition of preexisting condition exclusions (45 CFR § 147.108)
  • PART III—STATE FLEXIBILITY RELATING TO EXCHANGES §1324. LEVEL PLAYING FIELD. §§(1) guaranteed renewal; (2) rating; (3) preexisting conditions (45 CFR §147, 45 CFR §152); (4) non-discrimination; (5) quality improvement and reporting; (6) fraud and abuse; (7) solvency and financial requirements; (8) market conduct; (9) prompt payment; (10) appeals and grievances; (11) privacy and confidentiality; (12) licensure; and (13) benefit plan material or information.
  • PART A—Individual and Group Market Reforms ‘‘SUBPART II — Improving Coverage , § 2717. Ensuring the quality of care
  • Proposed H.R. 633 related to privacy and security of PHI related to insurance exchanges, “PROTECT Act”
  • 45 CFR §405.502 – Criteria for determining reasonable charges
  • Anti-Kickback Statute [fusion_builder_container hundred_percent=”yes” overflow=”visible”][fusion_builder_row][fusion_builder_column type=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none”][42 U.S.C. § 1320a-7b(b)]).


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