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NR 442
May 2020
Exam2
Chp: 4, 10, 11, 12, 13, 14, 19, 21, 23, 24, 25, 28
● Legislation related to health care
o Factors influencing legislation
▪ Federal policies and practices influence local and state governments
▪ Coordination of services under department of health and human services
o Gov’t role in health policy at local, state, and national levels
▪ Local: Local health departments (LHD) - Receives funds from the state
level to implement community level programs.
● The primary focus of a local health department is the health of its
citizens
● Local health departments offer various services and programs
● Local health departments are responsible for identifying and
intervening to meet the health needs of the local community
● Local health departments work closely with local officials,
businesses, and stakeholders.
● Local health departments report notifiable communicable diseases
to state departments of health
● Nurses at the community level typically function in the nursing
roles of caregiver, advocate, case manager, referral source,
counselor, educator, outreach worker, disease surveillance expert,
community mobilizer, and disaster responder.
● Funded through local taxes with support from federal and state
funds.
▪ State: State departments of health: Obtain funding from state legislature
and federal public health agencies.
● Manages the Women, Infants, and Children (WIC) program, which
promotes nutrition for women, infants, and children up to age five
who are of low socioeconomic status.
● Oversees Children’s Health Insurance Program (CHIP), which
offers expanded health coverage to uninsured children whose
families do not qualify for Medicaid.
● Establishes public health policies
● Provides assistance/support for local health departments
● Responsible for the administration of the Medicaid program
● Reports notifiable communicable diseases within the state to the
CDC
● State boards of nursing:
o Development and oversight of the state’s nurse practice act.
, o Licensure of registered and licensed practical nurses.
o Oversight of the states school of nursing.
▪ Federal: Most health related activities at the federal level are implemented
and administered by the United States Department of Health and Human
Services, which consists of 11 major agencies. The HHS is:
● Under the direction of the Secretary of Health
● Funded through federal taxes
● Veterans Health Administration: Finances health services for
active and retired military persons and dependents (within the U.S.
Department of Veterans Affairs)
▪ National: WHO
● Provides daily information regarding the occurrence of
internationally important diseases.
● Establishes world standards for antibiotics and vaccines
● Primarily focuses on the health care workforce and education,
environment, sanitation, infectious diseases, maternal and child
health, primary care.
▪ Government agencies: The 11major agencies that the HHS oversees are:
o Administration for Community Living (ACL)
o Administration for Children and Families (ACF)
o Centers for Medicare and Medicaid Services (CMS)
o Agency for Healthcare Research and Quality (AHRQ)
o Centers for Disease Control and Prevention (CDC)
o Agency for Toxic Substances and Disease Registry
(ATSDR)
o Food and Drug Administration (FDA)
o Health Resources and Service Administration (HRSA)
o Indian Health Services (IHS)
o National Institutes of Health (NIH)
o Substances Abuse and Mental health Services
Administration (SAMHSA)
o Hill-Burton Act
▪ In 1946, Congress passed a law that gave hospitals, nursing homes and
other health facilities grants and loans for construction and modernization.
▪ Federal assistance in construction of hospitals with stipulations about
service for the uninsured,
▪ Federal assistance/grants to construct hospitals, rural hospitals, nursing
homes, health facilities with stipulations about service for uninsured
patients.
▪ Treat regardless of race, nationality, financial background, medicare or
medicaid status
▪ U.S. federal law passed in 1946
o COBRA
▪ Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)
, ▪ Required all EDs that participate in Medicare to provide care for all,
regardless of ability to pay
▪ Ensured continuation of insurance after loss of job
▪ Example of how federal government can affect state health care practices
o Social Security Act
▪ Social Security Act of 1935; 1965; 1972
▪ Benefits for mothers, children, elderly, disabled
▪ Social Security Act of 1935 and its amendments (1965, 1972): The Social
Security Act and its subsequent amendments have had a far-reaching
effect on health care for many groups. The Social Security Administration
(SSA) provides welfare for high-risk mothers and children. Benefits were
later expanded to include health care provisions for older adults and the
handicapped. This major governmental action was the enactment of
legislation for Medicare and Medicaid.
o Medicare and Medicaid
▪ Medicare (Title XVIII) in 1965
● Health care services for people over 65, with permanent
disabilities, and those with end-stage renal disease. This federal
program, administered by the Centers for Medicare and Medicaid
Services (CMS; formerly Health Care Financing Administration
[HCFA]), pays specified health care services for all people 65
years of age and older who are eligible to receive Social Security
benefits. People with permanent disabilities and those with
end-stage renal disease are also covered. The objective of
Medicare is to protect older adults and the disabled against large
medical outlays. The program is funded through a payroll tax of
most working citizens. Individuals or providers may submit
payment requests for health care services and are paid according to
Medicare
▪ Medicaid (Title XIX of the socials security act) in 1965
● Joint state and federal program
● Universal health care coverage for: indigent, children, women,
disabled, impoverished elders, and adults below poverty line in
some states.
● Medicaid, Title XIX Social Security Amendment (1965): Each
state is allocated federal dollars on a matching basis (i.e., 50% of
costs are paid with federal dollars). Each state has the
responsibility and right to determine the services to be provided
and the dollar amount allocated to the program.
● Basic services (e.g., ambulatory and inpatient hospital care,
physical therapy, laboratory, radiography, skilled nursing, and
home health care) are required to be eligible for matching federal
dollars.
● States may choose from a wide range of optional services, such as,
inpatient and outpatient hospital care, pregnancy-related care,
NR 442
May 2020
Exam2
Chp: 4, 10, 11, 12, 13, 14, 19, 21, 23, 24, 25, 28
● Legislation related to health care
o Factors influencing legislation
▪ Federal policies and practices influence local and state governments
▪ Coordination of services under department of health and human services
o Gov’t role in health policy at local, state, and national levels
▪ Local: Local health departments (LHD) - Receives funds from the state
level to implement community level programs.
● The primary focus of a local health department is the health of its
citizens
● Local health departments offer various services and programs
● Local health departments are responsible for identifying and
intervening to meet the health needs of the local community
● Local health departments work closely with local officials,
businesses, and stakeholders.
● Local health departments report notifiable communicable diseases
to state departments of health
● Nurses at the community level typically function in the nursing
roles of caregiver, advocate, case manager, referral source,
counselor, educator, outreach worker, disease surveillance expert,
community mobilizer, and disaster responder.
● Funded through local taxes with support from federal and state
funds.
▪ State: State departments of health: Obtain funding from state legislature
and federal public health agencies.
● Manages the Women, Infants, and Children (WIC) program, which
promotes nutrition for women, infants, and children up to age five
who are of low socioeconomic status.
● Oversees Children’s Health Insurance Program (CHIP), which
offers expanded health coverage to uninsured children whose
families do not qualify for Medicaid.
● Establishes public health policies
● Provides assistance/support for local health departments
● Responsible for the administration of the Medicaid program
● Reports notifiable communicable diseases within the state to the
CDC
● State boards of nursing:
o Development and oversight of the state’s nurse practice act.
, o Licensure of registered and licensed practical nurses.
o Oversight of the states school of nursing.
▪ Federal: Most health related activities at the federal level are implemented
and administered by the United States Department of Health and Human
Services, which consists of 11 major agencies. The HHS is:
● Under the direction of the Secretary of Health
● Funded through federal taxes
● Veterans Health Administration: Finances health services for
active and retired military persons and dependents (within the U.S.
Department of Veterans Affairs)
▪ National: WHO
● Provides daily information regarding the occurrence of
internationally important diseases.
● Establishes world standards for antibiotics and vaccines
● Primarily focuses on the health care workforce and education,
environment, sanitation, infectious diseases, maternal and child
health, primary care.
▪ Government agencies: The 11major agencies that the HHS oversees are:
o Administration for Community Living (ACL)
o Administration for Children and Families (ACF)
o Centers for Medicare and Medicaid Services (CMS)
o Agency for Healthcare Research and Quality (AHRQ)
o Centers for Disease Control and Prevention (CDC)
o Agency for Toxic Substances and Disease Registry
(ATSDR)
o Food and Drug Administration (FDA)
o Health Resources and Service Administration (HRSA)
o Indian Health Services (IHS)
o National Institutes of Health (NIH)
o Substances Abuse and Mental health Services
Administration (SAMHSA)
o Hill-Burton Act
▪ In 1946, Congress passed a law that gave hospitals, nursing homes and
other health facilities grants and loans for construction and modernization.
▪ Federal assistance in construction of hospitals with stipulations about
service for the uninsured,
▪ Federal assistance/grants to construct hospitals, rural hospitals, nursing
homes, health facilities with stipulations about service for uninsured
patients.
▪ Treat regardless of race, nationality, financial background, medicare or
medicaid status
▪ U.S. federal law passed in 1946
o COBRA
▪ Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)
, ▪ Required all EDs that participate in Medicare to provide care for all,
regardless of ability to pay
▪ Ensured continuation of insurance after loss of job
▪ Example of how federal government can affect state health care practices
o Social Security Act
▪ Social Security Act of 1935; 1965; 1972
▪ Benefits for mothers, children, elderly, disabled
▪ Social Security Act of 1935 and its amendments (1965, 1972): The Social
Security Act and its subsequent amendments have had a far-reaching
effect on health care for many groups. The Social Security Administration
(SSA) provides welfare for high-risk mothers and children. Benefits were
later expanded to include health care provisions for older adults and the
handicapped. This major governmental action was the enactment of
legislation for Medicare and Medicaid.
o Medicare and Medicaid
▪ Medicare (Title XVIII) in 1965
● Health care services for people over 65, with permanent
disabilities, and those with end-stage renal disease. This federal
program, administered by the Centers for Medicare and Medicaid
Services (CMS; formerly Health Care Financing Administration
[HCFA]), pays specified health care services for all people 65
years of age and older who are eligible to receive Social Security
benefits. People with permanent disabilities and those with
end-stage renal disease are also covered. The objective of
Medicare is to protect older adults and the disabled against large
medical outlays. The program is funded through a payroll tax of
most working citizens. Individuals or providers may submit
payment requests for health care services and are paid according to
Medicare
▪ Medicaid (Title XIX of the socials security act) in 1965
● Joint state and federal program
● Universal health care coverage for: indigent, children, women,
disabled, impoverished elders, and adults below poverty line in
some states.
● Medicaid, Title XIX Social Security Amendment (1965): Each
state is allocated federal dollars on a matching basis (i.e., 50% of
costs are paid with federal dollars). Each state has the
responsibility and right to determine the services to be provided
and the dollar amount allocated to the program.
● Basic services (e.g., ambulatory and inpatient hospital care,
physical therapy, laboratory, radiography, skilled nursing, and
home health care) are required to be eligible for matching federal
dollars.
● States may choose from a wide range of optional services, such as,
inpatient and outpatient hospital care, pregnancy-related care,
