Regulatory and Legislative Factors, Research Paper Example

There are many regulatory and legislative factors that are affecting healthcare reimbursement and care practices in my healthcare organization. While we have to regularly deal with Medicare and Medicaid policies, we now have to adapt to the reimbursement processes that adhere to the Affordable Care Act and the alterations to existing policies that is associated with this law. Currently, many health insurance policies have a limit on the amount of care a patient is allowed to receive for a condition. In light of the Affordable Care Act, there is a growing concern about whether Health Reimbursement Arrangements (HRAs) will be permissible (Sibson Consulting, 2013).

To make the reimbursement process clear for practices that deal with health insurance provided by the Affordable Care Act, the United States Department of Labor provided a brief explanation of the coverage in September 2013 (U.S. Department of Labor, 2013). According to this document, a HRA is defined as “an arrangement that is funded solely by an employer and that reimburses an employee for medical care expenses incurred by the employee, or his spouse, dependents”. The Affordable Care Act states that health insurance with group plans are not allowed to set dollar limits for an individual although there may be a yearly limit on the number of non-essential health visits that are allowed. Furthermore, individuals will be generally allowed preventative visits without cost-sharing requirements.

It is important to continue to conduct research on how the Affordable Care Act affects healthcare institutions because there are many rules regarding reimbursement that must be learned prior to when the patient receives care. It is unfortunately a lengthy law and has many different applications in this field. However, to ensure reimbursement occurs, it must be understood.

References

Sibson Consulting. (2013). Healthcare Reform Insights. Retrieved from http://www.sibson.com/publications/HCRI/march2013HRAs.pdf

U.S. Department of Labor. (2013). Application of Market Reform and other Provisions of the

Affordable Care Act to HRAs, Health FSAs, and Certain other Employer Healthcare Arrangements. Retrieved from http://www.dol.gov/ebsa/newsroom/tr13-03.html