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U.S. health law and policy, 2001 : a guide to the current literature

Author: Donald H Caldwell; American Health Lawyers Association.
Publisher: San Francisco : Jossey-Bass ; Chicago : Health Forum, ©2001.
Series: Jossey-Bass/AHA Press series.
Edition/Format:   Print book : English : 1st edView all editions and formats
Database:WorldCat
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Genre/Form: Abstracts
Resource Guides
Bibliography
Additional Physical Format: Online version:
Caldwell, Donald H. (Donald Harrison), 1959-
U.S. health law and policy, 2001.
San Francisco : Jossey-Bass ; Chicago : Health Forum, ©2001
(OCoLC)606585861
Material Type: Internet resource
Document Type: Book, Internet Resource
All Authors / Contributors: Donald H Caldwell; American Health Lawyers Association.
ISBN: 0787955043 9780787955045
OCLC Number: 45621036
Notes: "American Health Lawyers Association"--Cover.
Description: xxi, 593 pages ; 29 cm.
Contents: Part 1 Medical Facilities and Organizations --
Chapter 1 An Overview of Health Law 3 --
Chapter 2 Health Care Facilities and Settings 13 --
2.01 In General 13 --
2.02 Hospitals 16 --
(1) In General 16 --
(2) Rural Hospitals 23 --
(3) Academic Medical Centers 24 --
(4) Religious Medical Institutions 26 --
2.03 Nursing Homes 27 --
2.04 Medical Offices 37 --
2.05 Home Health Care 38 --
2.06 Assisted Living Facilities 41 --
2.07 Hospices 41 --
Chapter 3 Managed Care Organizations 43 --
3.01 The Health Maintenance Organization (HMO) Model of Care 46 --
3.02 HMO Model Types 51 --
3.03 State Regulation of HMOs 53 --
3.04 Point-of-Service (POS) Product Regulation 55 --
3.05 Other State Laws 55 --
(1) State Insurance Laws 56 --
(2) Coordination of Benefits 56 --
(3) Certificate-of-Need Laws 56 --
(4) State Rate-Setting Laws 56 --
(5) Any-Willing-Provider Laws 56 --
(6) Small-Group Insurance Reform 56 --
3.06 Federal Qualification 57 --
3.07 Government Reimbursement Programs 57 --
(1) Products for Medicare Beneficiaries 57 --
(2) Medicaid Contracting 59 --
(3) The Federal Employees Health Benefit Program (FEHBP) 60 --
(4) State Government 60 --
3.08 HMO Management and Operational Issues 60 --
(1) Internal Organization and Controls 60 --
(2) Employer Agreements 62 --
(3) Provider Relationships 62 --
(a) Provider Credentialing 62 --
(b) Provider Contracts --
Compensation Arrangements 63 --
(c) Provider Contracts --
Nonrate Issues 64 --
(d) HMO Liability for Provider Malpractice 65 --
(e) Rate Setting and Financial Strategy 65 --
3.09 Mergers and Closures 66 --
3.10 HMO Grievance Procedures 66 --
3.11 Preferred Provider Organizations (PPOs) 68 --
Chapter 4 Integrated Delivery Systems 69 --
4.02 Advantages and Disadvantages of Integration 86 --
(1) Potential Barriers to Integration 86 --
(2) Financial Issues 86 --
(3) Structure and Degree of Integration 87 --
4.03 Common Legal Issues 88 --
4.04 Particular Network Issues 90 --
(1) Acquisition of Physician Practices 91 --
(2) Types of Acquisition 93 --
(3) Structuring Payment 94 --
(4) The Management Service Organization (MSO) Model 95 --
(5) The Physician Hospital Organization (PHO) 95 --
(6) Foundation Models 97 --
(7) Capitation Issues 97 --
(8) Medical Practice Mergers 98 --
(9) Rural Hospital Networks 99 --
(10) Freestanding Outpatient Facilities and Services 100 --
(11) Joint Ventures 101 --
(12) Unwinding Deals 102 --
Chapter 5 Utilization Review 105 --
5.02 Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) 110 --
Part 2 Regulatory Matters --
Chapter 6 Tax Issues 115 --
6.01 The Section 501(c) Exempt Institution: Qualifying for and Maintaining the Exemption 115 --
(1) The 501(c) Exemption: Advantages and Disadvantages 118 --
(2) Charitable Purpose Defined 121 --
(b) Charitable Hospitals 122 --
(c) Charitable Nursing Homes 125 --
(d) Charitable Professional Standards Review Organizations 125 --
(e) Charitable Share Service Organizations 125 --
(f) Individual Practice Associations 125 --
(g) Faculty Group Practice Plans 126 --
(h) Integrated Delivery Systems 126 --
(i) Physician Hospital Organizations 126 --
(j) Other Charitable Organizations 127 --
(k) Intermediate Sanctions 127 --
6.02 Unrelated Business Income Tax (UBIT) 129 --
6.03 Application of Federal Tax Laws to Corporate Restructuring and Joint Venturing 130 --
6.04 State and Local Taxes 133 --
6.05 Tax-Exempt Financing 134 --
6.06 Taxation of Health Benefits 135 --
6.07 Audit Issues 135 --
6.08 For-Profit Conversion Issues 137 --
Chapter 7 Antitrust Issues 143 --
7.01 General Application of Antitrust Principles to Health Care 143 --
7.02 Antitrust Issues Raised by Provider Activities 149 --
7.03 Merger and Joint Venture Developments 153 --
7.04 Antitrust Implications of Integrated Delivery Systems 160 --
7.05 Government Enforcement Activities 164 --
Chapter 8 Provider Reimbursement Issues 169 --
8.02 Medicare 175 --
(2) Part A: Inpatient Services Related to Acute Hospital Inpatient Care 179 --
(a) Diagnosis-Related Groups 179 --
(b) Special Payment Rules for Certain Costs 180 --
(3) Part B: Outpatient and Physician Services 182 --
(4) Medicare+Choice Program 183 --
(5) Home Health Care 186 --
8.03 Medicaid 187 --
(1) General Framework 187 --
(2) Reimbursement Principles 190 --
(3) Recent Reforms 191 --
8.04 Reimbursement Review Activities: Peer Review Organizations 200 --
8.05 Fraud and Abuse Statutes: Proscribed Conduct 200 --
(1) False Statements or Claims 203 --
(2) Illegal Remuneration (Stark I and II) 214 --
(3) Other Illegal Acts 218 --
8.06 Civil Monetary Penalties Law 221 --
(1) Proscribed Conduct 221 --
(2) Civil Monetary Act Procedures 222 --
8.07 Audits 222 --
8.08 Private Insurance 223 --
Chapter 9 Bankruptcy and Insolvency 227 --
9.02 Hospitals 230 --
9.03 Managed Care Organizations 230 --
Chapter 10 Health Care Planning 233 --
10.01 The National Health Planning Act 234 --
10.02 Planning Activities 235 --
Chapter 11 Regulation of Private Health Care Financing 239 --
11.01 Regulation of Private Insurance 240 --
11.02 The Employee Retirement Income Security Act of 1974 (ERISA) 243 --
11.03 Regulation of Managed Care 249 --
Part 3 Licensure, Liability, and Labor Issues --
Chapter 12 Licensure of Health Care Professionals 253 --
12.01 Physicians 255 --
12.02 Nurses 256 --
12.03 Physician Assistants 258 --
Chapter 13 Professional Relationships in the Health Care Enterprise 261 --
13.01 Medical Staff Issues 262 --
13.02 Quality 264 --
13.03 Professional Peer Review 267 --
13.04 Physician Deselection 270 --
Chapter 14 Labor Issues 273 --
14.02 Physician Unionization 276 --
Chapter 15 Liability of Health Care Professionals 279 --
15.01 Liability for Patient Injury 279 --
15.02 Obligation to Obtain a Patient's Informed Consent 294 --
15.03 Obligation to Report Abuse 299 --
Chapter 16 Liability of Health Care Institutions 301 --
Chapter 17 Liability of Managed Care Organizations 311 --
17.02 Tort Liability 316 --
17.03 Liability for Provider Exclusion 321 --
Chapter 18 Obligations to Provide Medical Care and Access 323 --
18.02 Emergency Medical Treatment and Active Labor Act (EMTALA) 328 --
18.03 Obligations to Provide Care Under State Law 332 --
18.04 Obligations under the Hill-Burton Act 333 --
18.05 Nondiscrimination Obligations Under Title VI of the Civil Rights Act of 1964 334 --
18.06 Discrimination Against Persons Based on Medical Condition 335 --
18.07 Financial Criteria 335 --
(1) Denial of Nonemergency Treatment for Financial Reasons 335 --
(2) Termination of Nonemergency Treatment for Financial Reasons 336 --
18.08 Grievance and Appeal Procedures 336 --
18.09 Health Insurance Portability and Accountability Act of 1996 (HIPAA or Kennedy-Kassebaum) 337 --
18.10 Balanced Budget Act of 1997 (BBA) 339 --
Chapter 19 AIDS Issues 343 --
19.02 Legal Issues Relating to Treatment of Patients with AIDS or HIV Infection 352 --
(1) Duty to Treat 352 --
(2) HIV Testing of Patients 353 --
(3) Duty to Provide a Safe Workplace 355 --
(4) Privacy 355 --
19.03 Issues Relating to Health Care Professionals with AIDS or HIV Infection 358 --
(1) Risk of Transmission 358 --
(2) Employment Laws: Legal Protections for Employees with HIV 359 --
(a) Prohibition Based on Handicap 359 --
(b) General Duty of Employer to Deal Fairly 359 --
(c) Other Sources of Employment Rights 360 --
Chapter 20 Environmental Concerns Affecting Health Care Facilities 363 --
20.02 Waste 366 --
(2) Regulated Medical Waste 366 --
(b) Regulating Agencies 367 --
(c) Medical Waste Tracking Act 368 --
(d) Segregation, Packaging, and Labeling of Medical Waste 368 --
(e) Disposal Techniques 368 --
(i) Incineration 369 --
(ii) Autoclaving 370 --
(iii) Landfilling 370 --
(iv) Microwaving, Irradiation, and Chemical Disinfection 370 --
20.03 Emergency Planning and Community Right-to-Know Act (EPCRA) 370 --
Chapter 21 Medical Records and Privacy Issues 373 --
21.02 Privacy Issues 378 --
21.03 Information Garnered from Genetic Testing 385 --
21.04 Telemedicine 396 --
Chapter 22 Health Care Reform 401 --
Appendix A Health Law Periodicals, Digests, and Newsletters 421 --
Appendix B Reference Sources and Government Serials 455 --
Appendix C Computer Databases and Internet Sites 457 --
Appendix D State-by-State Synopsis of Selected Statutes of Limitation Laws 471 --
Appendix E Table of Acronyms and Abbreviations 473 --
Appendix G Relevant Federal Agencies 513 --
Appendix H Selected Nongovernmental Agencies 523 --
Appendix I State Laws Governing Medical Records 533 --
Appendix J Health Care Financing Administration Regional Offices 547.
Series Title: Jossey-Bass/AHA Press series.
Other Titles: US health law and policy, 2001
United States health law and policy, 2001
Responsibility: Donald H. Caldwell, Jr.
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