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Canyon College

online regulatory environment course at Canyon College

HS430: Healthcare Regulatory Environment


Course Title: HS430 - Healthcare Regulatory Environment
Department: Health Sciences
Instructor: Jean Hope, MBA, RN, LRC, CDMS, CCM, LNCC - Vita


Syllabus - Please print this Syllabus for your reference. The Syllabus contains hyperlinks for easy access.
Index:
Course Title
Instructor
Textbook
Course Description
Objectives
Course Topics
Grades 		Content Analytical Scoring
Student Responsibilities
Instructor Availability
Feedback
Academic Dishonesty
Outline
End

Overview

Textbook: Online Bookstore

Kavaler, F. and A. Spiegel. Risk Management in Health Care Institutions: A Strategic Approach. Second Edition. Jones and Bartlett Publishers, 2003. ISBN: 0763723142

Check your text to ensure that it matches the required text, above. Use the lecture material as a supplementary resource. Internet resources are listed in the lecture material and are used to supplement readings.

Course Description:

This course is designed to introduce the Healthcare Administration student to the issues and demands of the regulatory environment that affect healthcare in the United States today. It covers concepts such as public policy, risk management, and fraud and abuse, as well as a discussion of the Healthcare Administrator’s role in organizational compliance, including licensing and accreditation. The roles of local, state, and federal regulatory agencies and accrediting bodies, and the enforcement of federal guidelines, standards, and regulations are also included.

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Objectives and Course Topics

Objectives:
  1. Describe at least four major issues associated with the regulatory environment in US healthcare today.
  2. Identify agencies involved in healthcare regulation at the federal, state, and local levels.
  3. Discuss the value of accreditation and the administrator’s role in the process.
  4. Discuss the role of the healthcare administrator in maintaining compliance with regulations and accreditation, including plans of correction.
  5. Describe the principles of risk management and the healthcare administrator’s role in program oversight.
  6. Discuss fraud and abuse, including the components of a corporate compliance program.
  7. Identify the legal issues present in healthcare today and the role of the healthcare administrator.
  8. Identify ethical issues involved in healthcare administration.
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Course Topics:
  1. Overview of the regulatory environment
  1. federal, state, and local authority
  2. accreditation
  3. licensing
  4. professional practice acts
  5. consumer advocacy groups
  1. Regulatory Agencies
  1. Department of Health and Human Services
  2. Centers for Medicare and Medicaid Services
  3. Office of the Inspector General
  4. Department of Justice
  5. State Department of Health Services
  6. State Department of Insurance
  7. State Department of Corporations
  8. State Attorney General's Office
  1. Accrediting Agencies
  1. JCAHO
  2. NCQA
  3. AAHC
  4. AAAHC
  5. CARF
  1. Administrative roles and responsibilities in regulatory compliance and accreditation
  2. Principles of Risk Management
  3. Fraud, abuse, and corporate compliance
  4. Legal Issues
  1. negligence
  2. contracts
  3. unfair trade practices
  4. antitrust
  5. crimes
  6. employer-employee
  1. Ethical Issues
  1. patient rights
  2. confidentiality
  3. access to healthcare
Grades

Grades:
The syllabus is the OFFICIAL course work outline. You must complete and post all assignments for grading within one week of accessing the assignment.

***** All assignments are to contain a heading, which is to include the student’s name, the name of the school, the course number and title of the course, the assignment number, and the date, unless the student has been instructed differently.

Review Aaron, Jane E. (2001).The Little Brown Compact Handbook, 4th ed. New York: Addison-Wesley Educational Publishers, Inc for reference citations.

Overview - Outline - Return to Index

The grade you receive in this course reflects your performance in the following areas.

Discussion surrounding the course objectives
Exercises and Discussion Questions
Exercises are designed to enhance lecture and reading assignments. Each lecture contains a discussion question at the end of the lecture. Responses should be concise, well thought out, and substantive in nature to earn the maximum number of points.

Mid-Term Exam
The mid-term exam will be posted at the end of the fourth session and must be completed within 72 hours of posting.

Final Exam
The final exam will be posted at the end of the eighth session and must be completed within 72 hours of posting.

Content: ANALYTICAL SCORING GUIDE

I - CONTENT AND DEVELOPMENT - Key elements of the assignment must be covered. Content must be comprehensive / accurate / persuasive. The assignment must be clear, focused, and interesting and include relevant material or effective research and convey more than a general message. The student must demonstrate an understanding of the subject matter and the ability to link theories to practical experience. The student must support major points with specific details / examples. Research must be adequate and timely.

II - ORGANIZATION The assignment must be organized and must emphasize the central theme or purpose, and demonstrate an accurate and effective analysis. The central theme must be clear immediately. The structure must be clear, logical, and easy to follow. The ideas must be logical and well sequenced. The assignment must contain appropriate sections, including an introduction and conclusion, if appropriate. Each paragraph must contain only one main idea and be logically developed. Subsequent sections must develop / support the central theme, and the conclusions / recommendations must follow logically from the body of the paper.

III - STYLE / MECHANICS FORMAT – Citations / references must follow APA format. The student must properly cite ideas / information from other sources; the information must be laid out effectively, using headings and other reader-friendly tools. The assignment must be neat / show attention to detail, and be complete and accurate. REFERENCES (POINTS DETERMINED BY INDIVIDUAL ASSIGNMENT, WHEN APPROPRIATE) – Citations must be complete and accurate.

GRAMMAR / PUNCTUATION / SPELLING – Rules of grammar, usage, punctuation must be followed; spelling must be correct.

READABILITY / STYLE - Sentences must be complete, clear and concise. They must be well constructed, with consistently strong, varied structure that makes reading easy. Transitions between sentences / paragraphs / sections must help maintain the flow of thought. Words must be precise and unambiguous. Words must convey the intended message in a precise manner and must demonstrate the use of appropriate verbs, active voice, and appropriate vocabulary, and avoid the use of colloquial expressions and jargon. The student must demonstrate a strong grasp of standard writing conventions including spelling, proper punctuation, grammar and word usage, and use this ability to enhance the paper’s readability. The paper must be carefully edited and professional in appearance.

***** You must submit Assignments in 12 point, Arial font as Word Attachments (Virus Free).

If the attachment contains a virus, I will not grade it, and you will receive a zero for the assignment.
Session Student Assignment Assignment Length Content / Organization Sentence structure / grammar / punctuation / word choice Total Points for each assignment Percentage of Grade
Sessions 1-8
Each session consists of one exercise and one discussion question.		 Each session contains one Exercise 200 – 250 words 8 points 2 points 10 points 1.55% each
Each lecture contains one Discussion Question 200 – 250 words 8 points 2 points 10 points 1.55% each

Total points for Sessions 160 points 25%

Mid-Term 100 points 25%

Final Exam 100 points 25%

Final Points / Grade Percentage 360 points 100%


Grade Ranges Total of 360 points possible
A = 324 – 360 points D = 213 – 249 points
B = 287 – 323 points F = 212 points or less
C = 250 – 286 points

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Student Responsibilities and Instructor Availability

Student Responsibilities:

  1. Review weekly lecture
  2. Complete text and other readings as assigned
  3. Complete and post exercises
  4. Complete and post answers to discussion questions
  5. Complete exams as assigned
Instructor Availability:

The student may contact the instructor at any time through the e-mail address above and the instructor will respond usually within 24 - 48 hours.

Feedback

You will receive each written assignment back within one week with detailed comments and a score. If the instructor has any specific concerns about the student's progress, the student will be informed. If the student has any questions at any time about progress in the class, s/he can contact the instructor.

Academic Dishonesty

All work submitted by a student must represent the student's original endeavor. Where outside sources are used as references, work submitted by the student should identify the source and make clear the extent to which the student has utilized the source. Ideas or work presented in the private or public forums in the online electronic medium are subject to the same standards of honesty. Plagiarism and falsification of documents, including documents submitted for academic work, are serious matters.

Outline

Session1 Session2 Session3 Session4
Session5 Session6 Session7 Session8

Session 1: Overview of the regulatory environment

Lecture Objectives
* Discuss the extent of regulatory control in healthcare today

* Describe the impact of regulations upon healthcare organizations

Required Reading: Chapters 2 and 4

Exercise:
Visit the Press Room at http://www.hcla.org/ and discuss the findings in the Press Room, 2003 Briefing Book, section 2 on Improve Health Care Quality through Litigation Reform .

Outline

Session 2: Regulatory Agencies
Lecture Objectives:
* Identify the major regulatory agencies involved in the healthcare industry

* Discuss and evaluate the role of regulatory agencies

Required Reading: None

Exercise:
Contact your state or local Department of Health Services. Interview a representative and describe the Agency’s major role in healthcare in your area. How does the agency measure its success?

Outline

Session 3: Accrediting Agencies
Lecture Objectives:

* Identify the major accrediting agencies involved in the healthcare industry

* Evaluate the role of accrediting agencies

Required Reading: None

Exercise:
If you have participated in some type of accreditation survey in the past three years, briefly discuss your experience in preparation for, and during, the survey process. If you have not participated in an accreditation survey within the past three years, interview a manager from a healthcare organization and describe his / her experience in preparation for, and during, the survey process. In either scenario, what was the outcome of the accreditation survey process? If there were identified deficiencies, what impact would they have relative to Risk Management?

Outline

Session 4: Administrative Roles

Lecture Objectives:
* Analyze the role of the healthcare administrator in ensuring regulatory compliance

* Identify methods the healthcare administrator may use to maintain compliance with regulatory requirements

Required Reading: Chapters 8 and 9

Exercise:
Interview an individual who currently has an administrative role in a healthcare organization. Identify three important aspects of his / her role and discuss the relationship of these aspects to risk management.

Outline

Session 5: Principles of Risk Management

Lecture Objectives:
* Identify types of risks healthcare organizations face today

* Discuss the methods used to control risk in healthcare organizations

Required Reading: Chapters 1 and 3

Exercise:
If you are currently working in a healthcare setting, discuss one of the risk control techniques your organization has implemented. If you do not work in a healthcare setting, interview a risk manager in such a setting and discuss one risk control technique s/he uses. In either scenario, how did the organization / risk manager measure the success of the risk management technique that was utilized?

Outline

Session 6: Fraud, Abuse, and Compliance

Lecture Objectives:
* Describe fraud, abuse and compliance in the healthcare industry

* Identify measures being taken by government entities to eliminate fraud and abuse

* Discuss the components of a compliance program and the healthcare administrator’s role in developing such a program

Required Reading: Chapters 5 and 6

Exercise:
Identify the corporate compliance officer in the healthcare setting in which you work. Discuss his / her role. If you do not work in a healthcare setting, interview the corporate compliance officer in such a setting and discuss his / her role. In either scenario, identify one experience the compliance officer has had to respond to, as it related to fraud and / or abuse, which affected the entire organization.

Outline

Session 7: Legal Issues

Lecture Objectives:
* Evaluate the three potential liabilities healthcare organizations face today

* Explain the role of a healthcare administrator in liability

Required Reading: Chapters 11, 12, 13, 14 and 15

Exercise:
Select the major legal issue confronting your healthcare organization today and discuss its implications. If you are not currently working in a healthcare setting, contact someone in a healthcare organization in your area and interview him or her. Identify and discuss the major legal issue confronting his / her organization, the risk management implications, and why it is important to resolve the issue.

Outline

Session 8: Ethical Issues

Lecture Objectives:
* Discuss the major ethical issues facing healthcare organizations today compared with the major issues twenty years ago

* Assess the role of the healthcare administrator in these issues

Required Reading: Chapters 7 and 10

Exercise:
Discuss your role as a healthcare administrator in preserving patient confidentiality. Identify and discuss three scenarios whereby patient care staff can breach patient confidentiality. What are the major implications of each scenario? Identify one method you can use to protect patient information.

Outline

Return to Index

(end of syllabus HS 430
New: 06-20-2000
Revised: 10-4-2000, 06-09-02, 9-25-04, 9-19-2005, 3-16-2007