ATI Fundamentals Chapters 1-5
Regulatory Agencies - ANS-US Department of Health and Human Services
US FDA
State and local public health agencies
State licensing boards
The joint commission
Professional Standards Review organization
Utilization review committees
Function of State Licensing Boards - ANS-Ensure healthcare providers and agencies comply
with state regulations
Function of Professional Standards Review Organizations - ANS-Monitor health care services
provided
Function of Joint Commission - ANS-Sets quality standards for accreditation of health care
facilities
Function of Utilization review committees - ANS-monitor for appropriate dx and tx of
hospitalized clients
Medicare Part A - ANS-The part of the Medicare program that pays for hospitalization, care in a
skilled nursing facility, home health care, and hospice care.
Medicare Part B - ANS-The part of the Medicare program that pays for physician services,
outpatient hospital services, durable medical equipment, and other services and supplies. Also
available to those who have permanent disabliites
Medicare - ANS-A federal program of health insurance for persons 65 years of age and older
Medicare Part D - ANS-Medicare prescription drug reimbursement plans
Medicare Part C - ANS-managed care health plans offered to medicare beneficiaries under the
medicare advantage program
Medicaid - ANS-A federal and state assistance program that pays for health care services for
people who cannot afford them. Amt. of care is determined by the states
, Patient Protection and Affordable Care Act (PPACA) - ANS-2010 federal legislation designed
for comprehensive health reform, with an intent to expand coverage, control health care costs,
and improve the health care delivery system
State Children's Health Insurance Program (SCHIP) - ANS-a public health insurance program,
jointly funded by the federal and state governments, that provides health insurance coverage for
children whose families meet income eligibility standards. Insures up until age 19
Private Plans - ANS-Traditional insurance reimburses for services on a fee for service basis.
Private plans include: MCOs, PPOs, EPOs, and Long term care insurance
MCOs (Managed Care Organizations) - ANS-Primary care providers oversee comprehensive
care for enrolled clients and focus on prevention and health promotion
PPO's (Preferred Provider Org) - ANS-Clients choose from a list of contracted providers and
hospitals.
EPOs (exclusive provider organizations) - ANS-Clients choose from a list of providers and
hospitals within a contracted organization with no out of network coverage
long-term care insurance - ANS-Not covered by medicare. Provides long term care expenses
Preventive Health Care - ANS-focuses on education and equipping clients to reduce and
control risk factors for disease
Programs that promote immunization, stress management, occupational health and seat belt
use are examples of what level of health care? - ANS-Preventive
Primary Health care - ANS-emphasizes health promotion, and includes prenatal and well-baby
care, nutrition counseling, and disease control. is based on a sustained partnership between
client and provider.
Health care that includes office or clinic visits and scheduled school/work centered screenings
(vision, hearing, obesity) is an example of what level of health care? - ANS-Primary
Tertiary Health Care - ANS-acute care, involves the provision of specialized and highly
technical care
Intensive care, oncology centers and burn centers are examples of what level of health care? -
ANS-Tertiary
Secondary health care - ANS-includes the diagnosis and treatment of emergency, acute illness,
or injury.
Regulatory Agencies - ANS-US Department of Health and Human Services
US FDA
State and local public health agencies
State licensing boards
The joint commission
Professional Standards Review organization
Utilization review committees
Function of State Licensing Boards - ANS-Ensure healthcare providers and agencies comply
with state regulations
Function of Professional Standards Review Organizations - ANS-Monitor health care services
provided
Function of Joint Commission - ANS-Sets quality standards for accreditation of health care
facilities
Function of Utilization review committees - ANS-monitor for appropriate dx and tx of
hospitalized clients
Medicare Part A - ANS-The part of the Medicare program that pays for hospitalization, care in a
skilled nursing facility, home health care, and hospice care.
Medicare Part B - ANS-The part of the Medicare program that pays for physician services,
outpatient hospital services, durable medical equipment, and other services and supplies. Also
available to those who have permanent disabliites
Medicare - ANS-A federal program of health insurance for persons 65 years of age and older
Medicare Part D - ANS-Medicare prescription drug reimbursement plans
Medicare Part C - ANS-managed care health plans offered to medicare beneficiaries under the
medicare advantage program
Medicaid - ANS-A federal and state assistance program that pays for health care services for
people who cannot afford them. Amt. of care is determined by the states
, Patient Protection and Affordable Care Act (PPACA) - ANS-2010 federal legislation designed
for comprehensive health reform, with an intent to expand coverage, control health care costs,
and improve the health care delivery system
State Children's Health Insurance Program (SCHIP) - ANS-a public health insurance program,
jointly funded by the federal and state governments, that provides health insurance coverage for
children whose families meet income eligibility standards. Insures up until age 19
Private Plans - ANS-Traditional insurance reimburses for services on a fee for service basis.
Private plans include: MCOs, PPOs, EPOs, and Long term care insurance
MCOs (Managed Care Organizations) - ANS-Primary care providers oversee comprehensive
care for enrolled clients and focus on prevention and health promotion
PPO's (Preferred Provider Org) - ANS-Clients choose from a list of contracted providers and
hospitals.
EPOs (exclusive provider organizations) - ANS-Clients choose from a list of providers and
hospitals within a contracted organization with no out of network coverage
long-term care insurance - ANS-Not covered by medicare. Provides long term care expenses
Preventive Health Care - ANS-focuses on education and equipping clients to reduce and
control risk factors for disease
Programs that promote immunization, stress management, occupational health and seat belt
use are examples of what level of health care? - ANS-Preventive
Primary Health care - ANS-emphasizes health promotion, and includes prenatal and well-baby
care, nutrition counseling, and disease control. is based on a sustained partnership between
client and provider.
Health care that includes office or clinic visits and scheduled school/work centered screenings
(vision, hearing, obesity) is an example of what level of health care? - ANS-Primary
Tertiary Health Care - ANS-acute care, involves the provision of specialized and highly
technical care
Intensive care, oncology centers and burn centers are examples of what level of health care? -
ANS-Tertiary
Secondary health care - ANS-includes the diagnosis and treatment of emergency, acute illness,
or injury.
