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CHAPTER OBJECTIVES

CHAPTER OBJECTIVES

At the completion of this chapter, the reader will be able to:

  1. Describe how the laws, regulations, and policies affect the practice of physical therapy

  2. Describe the various methods of insurance reimbursements for healthcare services

  3. List the challenges associated with obtaining appropriate access to healthcare within the United States

  4. Describe the various associations and organizations that regulate the quality of healthcare

  5. Define malpractice and provide examples of patient negligence

  6. Describe the impact of the Balanced Budget Act of 1997

  7. Have a good understanding of patient rights within the healthcare system

  8. Describe how the Health Insurance Portability and Accountability Act (HIPAA) is designed to protect a patient’s privacy

  9. Discuss the various legislation that protects a patient within the healthcare system

  10. Describe the importance of the Americans with Disabilities Act (ADA) and its impact on society

  11. List some of the considerations when assessing the home and work environments

OVERVIEW

Over the years, several federal and state laws and regulations have been introduced to protect the public from safety issues, prevent medical fraud, and to control reimbursement. There exists a paradox of excess and deprivation in the healthcare system of the United States, in which some individuals are deprived of adequate care because they cannot afford suitable insurance, while others receive an excess of care that is expensive and unnecessary. Healthcare in the United States encompasses a wide spectrum, ranging from the highest quality, most compassionate treatment of those with complex illnesses, to the turning away of the very ill because of an inability to pay; from well-designed protocols for prevention of illness to inappropriate high-risk surgical procedures performed on uninformed patients.1 For the physical therapist, embarking on a career in healthcare, an understanding of how healthcare works, including its strengths and inadequacies, is essential.

CLINICAL PEARL

Law: A rule, or system of rules, conduct, or action, established by a country or community that regulates the actions of its members and which can be enforced by the imposition of penalties.

Statute: A law passed by a legislature. Statutes impacting the practice of physical therapy can be passed at the federal level (federal statutes) by Congress (see Federal Statutes), or at the state level (state statutes). An example of a state statute is the state physical therapy practice act which controls the scope and protection of physical therapy practice.

Policy: A proposed set of ideas or plans that describe a course or principle of action to be taken on a particular issue.

Practice act: A physical therapy practice act is a statute defining the scope and practice of physical therapy within the jurisdiction, outlining licensing requirements, and establishing penalties for violations of the law.

Regulation: A rule of order prescribed by a superior or competent authority, typically by various federal government departments and agencies, that has the force of law. Most commonly, at the state level, regulations give further definition to terms ...

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