MHA$/508$: Navigating The Regulatory Environment In Health Care

Wk $2$ Discussion $-$ State Regulations

I would like to answer the following classmates below but do not know how to respond:

Carletta Brown

The standard path to become a licensed gastroenterologist in Michigan is to complete medical school, earn a medical degree, do an internal medicine residency, and then pursue a gastrointestinal fellowship. Under its supervision, the Michigan Board of Medicine licenses doctors and verifies that they fulfill the state's requirements for practicing gastroenterology. In contrast to physicians, case managers might not need a specialized license. Nonetheless, they frequently have degrees in social work, nursing, or similar disciplines. Case managers may need different licenses or certifications depending on their state of practice and educational background.

Healthcare firms rely heavily on corporate compliance processes to make sure that state and federal rules are followed. These programs are intended to keep an eye on$,$ evaluate, and enhance an organization's compliance with the legal requirements that control the provision of healthcare. Policies and processes, employee training, routine audits, and channels for reporting and resolving issues are all common components of corporate compliance programs. Through consistent evaluation and enhancement of these initiatives, establishments can guarantee that their procedures conform to the most recent legal mandates.

These programs are critical to guaranteeing that healthcare businesses abide by various rules, such as HIPAA standards pertaining to patient privacy, Medicare and Medicaid regulations governing billing and coding, and other state$-$specific laws governing healthcare activities. Organizations can reduce the risk of legal problems and promote a culture of ethical and legal adherence by continuously implementing a strong compliance program.

Kayla Broadwater

Select a health care professional $($i$.$e$.,$ nurse practitioner, physician, nursing home administrator, pharmacist, etc.$)$ and describe the scope of practice that governs that profession. How does this vary from State to State?

In the healthcare profession of a nurse practitioner $($NP$)$ scope of practice varies by state. NP practice includes, but is not limited to$,$ assessment; ordering, performing, supervising and interpreting diagnostic and laboratory tests; making diagnoses; initiating and managing treatment, including prescribing medication and non$-$pharmacologic treatments; coordinating care; counseling; and educating patients, their families and communities $($American Association of Nurse Practitioners, $2022).$

The NP$$s scope of practice falls into three main levels for the authority of practice such as full, reduced or restricted practice authority.

Full Practice Authority: NP$$s can perform the full scope of practice without supervision or collaborating with a physician. This includes diagnosing a patient, order tests, prescribe medication, and operate their own independent practices $($Clarke$,2021).$

Reduced Practice Authority: NP$$s can perform some of their scope of practice without physician supervision $($Clarke$,2021).$

Restricted: NP$$s must work under the supervision of a physician for all their scope of practice $($Clarke$,2021).$

What are the licensure requirements in your State for your chosen healthcare practitioner? What license governs your career today or one you plan for your future?

In the state of Maryland, The Licensure requirements are to have an active RN license, master$$s or higher, National Certification Exam and submit application with fees.

How do Corporate Compliance programs ensure that healthcare organizations follow State and Federal Regulations?

Some healthcare providers are required to adopt compliance programs, but government recommends that all healthcare providers have a program even if not required to do so by law $($Carboni$,2022).$ Compliance programs are to support ethical environment and help to reduce fraud waste and abuse. Corporate Compliance programs ensure that healthcare organizations follow State and Federal Regulations through Compliance programs. Compliance programs are a formalized system of policies, procedures, and process developed and implemented to prevent, detect and correct conduct that is inconsistent with applicable federal and state laws, rules and regulations that govern a healthcare organization $($Carboni$,2022).$