Chap 1 q22-45

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Valencia College *

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Medicine

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Birth of Medicare and Medicaid 22. What year was the Social Security Act amended, creating Medicare and Medicaid? 1965 23. Did the American Medical Association support the creation of Medicare and Medicaid? No 24. In what way was Medicare structured like Blue Cross Blue Shield? It separated hospital services from physician services. 25. Under which President was Medicare eligibility extended to individuals with long-term disabilities or end-stage renal disease (ESRD)? Nixon 1972 1973 Federal HMO Act 26. What two key things did the HMO Act do? Provided funding for HMO development. Required employers with >25 employees to offer HMO plans, if available. Health Insurance in the 1970s 27. What does the Employee Retirement Income Security Act (ERISA) address? Employer plans. Protects employees and their dependents by establishing minimum standards for employer health, insurance, and welfare benefit plans, including life and disability insurance. ERISA 1974 does not require employers to offer benefit plans, but it regulates the operations of those benefit plans when offered. 28. What year were Preferred Provider Organizations (PPOs) created? 1978 29. What organization was created in 1979 to perform health plan accreditation? National Committee for Quality Assurance (NCQA) Health Insurance in the 1980s 30. Did HMO enroliment increase or decrease during the 1980s? Increase 31. What did the Tax Equity and Fiscal Responsibility Act (TEFRA) do? Authorized Medicare to contract with private HMOs. 1982 32. What did the Consolidated Omnibus Budget Reconciliation Act (COBRA) do? Provide workers and their families temporary employer health coverage for a limited time after certain events (job loss). 1985 (N
33. What did the Emergency Medical Treatment and Active Labor Act (EMTALA) do? Required hospital EDs to treat anyone experiencing an emergency or active labor, regardless of their ability to pay. 1986 Health Insurance in the 1990s-2000 34. Are all Blue Cross Blue Shield plans nonprofit? No 35. What type of specialized companies emerged during the 1990s-2000s? Carve-out companies 36. Provide two examples of carve-out companies Companies that focus on how best to manage behavioral healthcare or pharmacy services 37. What did hospitals do during the 1990s-2000s that increased their negotiating leverage? Hospital systems merged on a regional basis. 38. What did the Health Insurance Portability and Accountability Act (HIPAA) do? Protect personal health information, including electronic health records. 39. What two government programs were created under the Balanced Budget Act (BBA) of 1997? Medicare Part C Children’s Health Insurance Program (CHIP) 40. What did the Medicare Prescription Drug, Improvement, and Modernization Act create? Medicare Part D 41. Name three things that the Patient Protection and Affordable Care Act (PPACA) 2013 did. 1) Expanded health insurance coverage 2) Eliminated preexisting condition clauses 3) Placed new requirements on health plans HMO Backlash Leads to PPO Popularity 42. What led to the popularity of preferred provider organizations (PPOs)? Public concerns that healthcare decisions were being made by for-profit HMOs and that profits were driving denial decisions for needed care. Important medical treatments were being denied coverage by HMOs to increase profits. Also, concerns that employers were requiring employees to enroll with an HMO or charging more for any non-HMO health plan.
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