Nursing-110: Health Care Law & HIPAA
What is the initial examination fee for Licensure (RN/LPN)?
$110
If a nurse's license lapses, what is the fee for reactivation (renewing late)?
$200
List a few examples of why the Board of Nursing would place a nursing school on "conditional" approval?
(a) complaints relating to violations of the "minimum standards for nursing programs"; (b) denial, withdrawal or change of program accreditation status by a board-recognized national nursing accreditation agency or general academic accreditation agency; (c) failure to obtain board approval of changes that require approval of the board under "program changes"; (d) providing false or misleading information to students or the public concerning the nursing program; (e) continuous disruptions in retaining a qualified director or faculty, resulting in disorganization and breakdown of supervision and teaching of students; (f) non-compliance with the program's stated philosophy, objectives, policies, and curriculum resulting in unsatisfactory faculty/student achievement; (g) failure to provide clinical experiences necessary to meet the objectives of the nursing program; (h) less than a passing rate of 80% of first time writers of the national licensing examination;
What are minor attributes and what is an example in relation to health care law?
--Is a law/rule that has financial incentives attached --An example of this would be non-reimbursement for hospital acquired infections, injury from falls, etc.
The ANA standards of nursing practice describe and include:
-ANA standards of practice describes a competent level of nursing care as demonstrated by the critical thinking model known as the nursing process -The nursing processes encompasses significant actions taken by RNs and forms the foundation of the nurse's decision making
What are some exceptions to the rules of confidentiality?
-Child Abuse -Elder Abuse --There are laws that require reporting of suspected abuse
What other factors are related to confidentiality?
-Confidentiality after Death -Confidentiality of Professional Communication -Confidentiality and HIV -Third parties are at risk of harm? -Child and Elderly (Required to report)
What does HIPAA's accountability section entail?
-Consent/use of their personal health information -Right to access their health records -Amend/change information if necessary -Privacy and confidentiality of the patient's health care info
ANA Standards of Professional Performance describe and include:
-Describe a competent level of behavior in the professional role -All RNs are expected to engage in professional role activities -RNs are accountable for their professional actions to themselves, their healthcare consumers, their peers, and ultimately to society
What is the Nursing Practice Act?
-Describes how to get licensure and enter practice in that particular state -Explains how and when to renew your license -Defines educational requirements for entry into practice -Describes the process by which individual members of the Board of Nursing are selected and the categories of membership -Provides definitions and scope of practice for each level of nursing practice -Identifies situations that are grounds for discipline or circumstances in which a nursing license can be revoked or suspended -Identifies the process for disciplinary actions, including diversionary techniques -Outlines the appeal steps if the nurse feels the disciplinary actions taken by the Board of Nursing are not fair or valid
What is an example of Regulation in health care law?
-Examples include the Department of Health and Human Services (USDHHS) -There are 11 division --Centers for Disease Control and Prevention (CDC) --Food and Drug Administration (FDA)
What does HIPAA's portability section entail?
-Health care insurance cannot be lost with changing of a job -Cannot be denied coverage with new health care plan if there is a pre-existing condition
What is HIPAA's privacy rule?
-It imposes restrictions on the use/disclosure of personal health information -Gives pt's greater protection of their medical records -Hopefully provides pt's with greater peace of mind related to the security of their information
What are some state laws that have directly impacted healthcare?
-Licensing of Professionals - Scope of Practice -Licensing of Health Care Institutions -Public Health -Consent -Advanced Directives -Physician Assisted Suicide
How long is a permit to practice (graduate permit) valid for?
-May be issued for a period not to exceed 6 months from the receipt date of application
What are the Legal Aspects of Licensure?
-Receiving license to practice nursing is a privilege, not a right -License is granted by state after candidate has successfully met all requirements -Each state's Practice Act may be different from other state's acts -All states use the National Council Licensure Examination (NCLEX) -Permits people to offer special skills to the public, and it also provides legal guidelines for protection of the public
What are some patient rights that patients have when entering a health care facility?
-Right to Treatment -Right to Refuse Treatment -Right to Informed Consent * Establishment of Competency * Nurses' role regarding informed consent -Right to be free of restraint and seclusion -Right to privacy --These are disclosed when they agree to treatment at a health care facility
What are some laws that have impacted health care and/or nursing?
-Social Security Act of 1965 (Medicaid & Medicare) -Consolidated Omnibus Budget Reconciliation Act (COBRA) -Emergency Medical Treatment and Active Labor Act (EMTALA) -Patient Self-Determination Act (Living Wills/Advanced Directives) -Health Insurance Portability and Accountability Act of 1996 -Protection and Affordable Care Act of 2010 -Good Samaritan Law
What are the consequences of breaking civil laws? Example in nursing is what?
-The consequences of civil law violations are damages in the form of fines or specific performance of good works such as public service. -An example of a civil law violation for a nurse is negligence or malpractice.
Nursing Students are liable, responsible, and must separate what things going through school?
-You are liable if your actions cause harm to patients, as is your instructor, hospital, and college/university. -You are expected to perform as a professional when rendering care. -You must separate your student nurse role from your work as a certified nursing assistant (CNA).
If you are using an electronic medical record what factors should be kept in mind while using them?
-You should have a unique password-don't share with others -Do not access information on yourself, your family, your friends, staff or any other person. -You have a duty to report any breach in confidentiality Privacy Officer -Remember most computer systems can track all access to records. -Inappropriate access is punishable by federal and state law
What other factors do HIPAA rules lay out?
1) Can't talk about pt's outside of the hospital with anyone 2) Clinicians should only access the medical information that is needed for their job/clinical experience. (minimum necessary information) 3) We need patients to give permission before we can give information to others on their behalf 4) Keep medical records in a secure place-both paper & electronic.
Negligence/Malpractice, aka Tort Law involve what four elements that are required to be satisfied?
1) Duty 2) Breach 3) Causation 4) Harm
What are major attributes and who established them in relation to health care law?
1) Established by legislature, judiciary 2) Law that defines expected behaviors
What are the two classifications of crime?
1) Felony 2) Misdemeanor
What are the scopes and categories in health care law?
1) Legislation 2) Litigation 3) Regulation
What are some things to keep in mind in relation to HIPAA in the workplace?
1) Make sure that any paper documents that are not part of the medical record are shredded after use so that privacy of PHI is maintained 2) Communicate orally in a way that others not involved in the patient's care cannot hear you 3) Family requires a "code" if they call in to receive updates on medical condition
HIPAA rules require what things from health care workers?
1) To treat all things we learn about pt's confidential 2) Provide more control to patient's over their personal health information 3) Punish those who misuse pt info by imposing criminal and civil penalties
Private Health Information (PHI) can be used/disclosed without authorization for the following reasons:
1)To inform appropriate agencies 2)Public health activities related to disease prevention/control 3) To report victims of abuse, neglect or domestic violence 4) To funeral homes, tissue/organ banks 5) To avert a serious threat to health/safety
What kinds of things need to be documented to avoid fault in malpractice?
1. Clearly document the patient's physical and mental condition on admittance to and discharge from your health care facility or unit. 2. After any incident, such as a patient fall, the patient's physical and mental condition must be documented. 3. Document clearly any actions of a patient that demonstrate noncompliance with medical directives. 4. Document clearly when a patient complains and does not complain. 5. Be very careful when documenting what a patient states as opposed to what you think may have happened. 6. Document the patient's own admissions. 7. Document discharge instructions clearly. 8. Document allergies
Applicants who fail the NCLEX -RN may apply to retake exam a maximum of how many time?
4 times per year
What is the Board of Nursing?
An agency designated to apply laws to individuals
What is an attribute in relation to health care law?
An attribute was created by the government agency/authority to be considered "Health Care law"
How long is an initial RN license valid for?
An initial license is shall be valid for two (2) years
What are civil laws?
Civil laws protect the rights of individuals within our society and provide for fair and equitable treatment when civil wrongs or violations occur
What are criminal laws?
Criminal laws protect society as a whole and provide punishment for crimes, which are defined by municipal, state, and federal legislation
What is an example of a tort law?
Defining patient care quality diameters i.e. standards set for practice and care delivered
What is an example of a constitutional law?
Ensuring access to health care and living wills
How often are Registered Nurses required to complete the renewal process?
Every two years
What happens if a nurse does not complete the (30) hours of approved continuing education (CE) that must be accrued within the 24 months immediately preceding expiration of license?
Failure of licensee to meet the CE requirement for licensure shall result in the license not being renewed, reinstated, or reactivated
If a nursing program is placed on conditions what happens if the deficiencies are not corrected?
Failure to correct deficiencies within the designated time period will result in withdrawal of approval and involuntary closure of the program by the board
If a nurse does not renew their license by the required date, can the nurse continue to practice?
If a nurse does not renew their license by the required date the nurse does not hold a valid license and shall not practice nursing in New Mexico until the lapsed licensed has been reactivated.
What is an example of Legislation in health care law?
Is organizations like Medicare or Medicaid
What does prescriptive mean in relation to health care law?
It defines something that must be done
What does proscriptive mean in relation to health care law?
It defines something that must not be done
What is Health Care Law?
It is the collection of laws which have a DIRECT impact on the DELIVERY of health care OR on the RELATIONSHIPS among those in the business of health care OR between the providers and recipients of health care.
Where does Health Care Law majorly derive from?
It majorly derives from constitutional and tort laws
What is an example of Litigation in health care law?
Litigation Case: In re Quinlan - removing a patient from life support when there is no hope for recovery. Allows this action to take place without fear of civil or criminal penalty for health care provider. Prompted hospitals to start up "Ethics Committees." --Question to keep in mind for these is: Have the laws been followed which were placed by legislative powers who appoint regulatory bodies to monitor these laws?
A graduate nurse has a permit to practice and is currently working in a long term care facility as a GN (Graduate nurse). During this time the graduate nurse takes the NCLEX-RN examination and fails. Can this person continue to work as a graduate nurse? (Please give rationale to justify your answer)
No they cannot continue to work as a graduate nurse. Applicants who fail the first or any subsequent examination shall not practice nursing until such time as the applicant passes a nursing licensing examination.
A graduate nurse lives and plans on obtaining a RN license through the state of Colorado. The graduate nurse plans on working at San Juan Regional Medical Center. Is this graduate nurse eligible for a permit to practice? (please give rationale to justify your answer)
No, permits to practice will not be issued for applicants who declare residency in other compact states.
What are the requirements to be a faculty member who teaches full time?
Nursing faculty who teach full-time shall hold a graduate degree in nursing; faculty without a graduate degree may be employed for one year and then are required to complete a graduate degree within the next five years, an educational contract with evidence of progression will be submitted with program annual report.
If a nurse is admitted to the diversion program, are there possible restrictions for practice? If so, what are they?
Participants may be prohibited from access to narcotics, overtime, night shift work and agency/home health care work.
What are the requirements for successful discharge from the diversion program?
Participants who remain drug and alcohol free for three (3) full years and comply with all conditions of their diversion program contract for at least twenty-four (24) months may request discharge from the diversion program.
List some examples of why the board may deny, revoke or suspend any license?
Some examples include: 1) is guilty of fraud or deceit in procuring or attempting to procure a license or certificate of registration; (2) is convicted of a felony; (3) is unfit or incompetent; (4) is intemperate or is addicted to the use of habit-forming drugs; (5) is mentally incompetent; (6) is guilty of unprofessional conduct as defined by the rules and regulations adopted by the board pursuant to the Nursing Practice Act.
What are all of the ANA's Standards of Professional Performance?
Standard 1 - Assessment Standard 2 - Diagnosis Standard 3 - Outcome Identification Standard 4 - Planning Standard 5 - Implementation Standard 6 - Evaluation Standard 7 - Ethics Standard 8 - Education Standard 9 - Evidence-Based Practice and Research Standard 10 - Quality of Practice Standard 11 - Communication Standard 12 - Leadership Standard 13 - Collaboration Standard 14 - Professional Practice Evaluation Standard 15 - Resource Utilization Standard 16 - Environmental Health
Standards of Care are and include:
Standards of care are legal guidelines for defining nursing practice and identifying the minimum acceptable nursing care -Are set by every state -Set by state and federal laws that govern where nurses work -Joint commission requires policies and procedures
Applicants for initial RN licensure in New Mexico are subject to what type of criminal background checks?
State and National Note: If the criminal background check reveals a felony, what will the applicant have to do is submit copies of legal documents and other related information to the board after being notified. The board will make the determination if the applicant is eligible for licensure
What is the max student/faculty ratio in the clinical setting?
Student/faculty ratio in the clinical setting shall be based upon the level of students, the acuity level of the clients, the characteristics of the practice setting and shall not exceed 8:1
What does HIPAA stand for?
The Federal Health Insurance Portability and Accountability Act of 1996
What is the statute governing nurses in each state?
The Nurse Practice Act
How many members serve on the board of Nursing? How many nurses serve on the board? How many public members? Who appoints members to the board?
The board shall consist of four licensed nurses, one preferably a licensed practical nurse, and three members who shall represent the public and shall not have been licensed as registered or licensed practical nurses, nor shall the public members have any significant financial interest, direct or indirect, in the profession. -Members of the board shall be appointed by the governor for staggered terms of four years each.
What are the requirements to be an administrator (director) of a nursing program?
The nurse administrator shall hold at least one graduate degree in nursing and shall have experience in nursing practice, nursing education, curriculum and nursing administration
A nurse does not receive a renewal notice from the board of nursing. Who is responsible for making sure the license is renewed on time?
The nurse. Failure to receive notice renewal shall not relieve the licensee of the responsibility of renewing the license by the expiration date
T or F: Patients have the right to adequate notice concerning the use/disclosure of their PHI
True -The Notice of Privacy Practices must contain the patient's rights and the covered entities' legal duties -Patients are required to sign a statement that they were informed of and understand the privacy practices
How long must the applicant wait prior to retesting for the NCLEX-RN?
must wait 45 days to retest
If a nursing program fails to maintain a passing rate of 80% of first time test takers for NCLEX. What must the program do?
when a program fails to maintain a passing rate of 80% of first time writers for one year, a letter will be sent to the program notifying them that they are not in compliance with the rules and to provide the board with an assessment of possible problem areas within six (6) months; When a program fails to maintain a passing rate of 80% of first time writers for two consecutive years, a report addressing areas of concern with a plan for corrective action will be submitted to the board within six (6) months and an evaluation visit may be required.