AHLA Fundamentals of Health Law (Non-Members)

Recent Titles from the American Health Law Association

About the Authors

Preface

Acknowledgments

About the American Health Law Association

Chapter 1 Introduction to Health Care Law and Regulation

1.1 Introduction

1.2 Patient Autonomy

1.3 Medicare

1.4 Medicaid Fundamentals

1.5 State and Federal Regulation of Private Health Care Plans

1.6 Fundamentals of Health Law Fraud and Abuse

1.7 Health Care Information

1.8 Tax-Exemption Issues

1.9 Antitrust Law

1.10 Regulation of Hospitals

1.11 Representing Physicians

1.12 Post-Acute Providers and Suppliers

1.13 Health Care Transactions and Contracting

1.14 Dispute Resolution

1.15 The Future of Health Law

Chapter 2 Patient Autonomy and Bioethics

2.1 The Provider-Patient Relationship and Duty to Treat

2.2 Consent to Medical Treatment

2.3 End-Of-Life Decision Making

2.4 Human Reproduction

2.5 Organ Transplantation

2.6 Genetics

2.7 Conclusion

Chapter 3 Medicare

3.1 Introduction to Medicare

3.2 High-Level Overview of Medicare

3.3 Program Administration

3.4 Medicare Part A

3.5 Medicare Part B

3.6 Medicare Part C

3.7 Medicare Part D

Chapter 4 Medicaid Fundamentals

4.1 Introduction

4.2 The Evolution of the Medicaid Program

4.3 Administration

4.4 Eligibility

4.5 Covered Benefits

4.6 Reimbursement and Financing Mechanisms

4.7 Delivery Systems

4.8 The Impact of the Affordable Care Act on Medicaid

4.9 The Impact of NFIB v. Sebelius on Medicaid

4.10 The Impact of the Executive Branch on Medicaid

Chapter 5 State and Federal Regulation of Private Health Plans and Delivery Systems

5.1 The Basis of Regulation

5.2 State Regulation of Private Health Care Plans

5.3 Federal Regulation of Private Health Care Plans

5.4 Changes Related to the Covid-19 Pandemic

5.5 Consolidated Appropriations Act, 2021: Surprise Medical Billing Provisions and

Other Requirements

5.6 Conclusion

Chapter 6 Fundamentals of Health Law Fraud and Abuse

6.1 The Federal Health Care Programs’ Anti-Kickback Statute

6.2 Federal Anti-Kickback Safe Harbor Regulations

6.3 Federal “Sunshine Law”

6.4 Federal Physician Self-Referral Law (Stark Law)

6.5 Stark Law Exceptions

6.6 Federal Criminal Prohibitions of False Claims and Fraudulent Billing Practices

6.7 Federal Civil Prohibitions of False Claims and Fraudulent Billing Practices

6.8 Corporate Compliance Programs

6.9 Conclusion

Chapter 7 Health Care Information

7.1 Introduction

7.2 The Health Insurance, Portability and Accountability Act of 1996 (HIPAA)

7.3 Other Federal Regulations Applicable to Health Information

7.4 State Law Considerations

7.5 Conclusion

Chapter 8 Tax-Exemption Issues

8.1 Introduction

8.2 Exemption Requirements—Generally

8.3 Exempt Purpose Requirement: “Stand-Alone” Charitable

8.4 Exempt Purpose Requirement: Stand-Alone Charitable Purpose—Application of the Community Benefit Standard to Other Than Hospitals and Other Than Direct Providers of Health Care

8.5 Exempt Purpose Requirement: Stand-Alone Exempt Purpose—The “Lessening the Burdens of Government” Alternative

8.6 Exempt Purpose Requirement: “Derivative” or “Integral Part” Theory of Charitable Purposes of Health Care Organizations

8.7 Public Benefit Requirement

8.8 Private Inurement Prohibition

8.9 Intermediate Sanctions For Excess Benefit Transactions and the Rebuttable Presumption of Reasonableness

8.10 Unrelated Business Activities

8.11 Political Activity Prohibition

8.12 Lobbying Limitation

8.13 Practical Application of the Fundamental Exemption Requirements

8.14 Section 509(a) Public Charity Status

Chapter 9 Antitrust Law

9.1 Introduction

9.2 The Substantive Antitrust Statutes and Their Analyses

9.3 Exemptions, Immunities, and Scope of Coverage

9.4 Government Enforcement

9.5 Private Enforcement

9.6 Conclusion

9.7 References

Chapter 10 Regulation of Hospitals

10.1 Introduction

10.2 State and Local Regulations

10.3 Federal Regulation

10.4 Accreditation; Survey Activity

10.5 Conclusion

Chapter 11 Representing Physicians

11.1 Introduction

11.2 Life Cycle of Physician-Practice Association

11.3 Physician-Hospital Arrangements

11.4 Licensure and Credentialing

11.5 Reimbursement Issues

11.6 Telemedicine

11.7 Physician-Patient Relationships

11.8 Affiliation Agreements

11.9 Conclusion

Chapter 12 Post-Acute Providers and Suppliers

12.1 Introduction

12.2 Home Medical Equipment Suppliers

12.3 Home Health Care

12.4 Hospice Care

12.5 Long-Term Care

12.6 Home- and Community-Based Services—Long-Term Services and Supports

12.7 Outpatient Treatment for Substance use Disorder—Opioid Treatment Programs

Chapter 13 Health Care Transactions and Contracting

13.1 Introduction

13.2 Getting Started: Initial Discussions and Preliminary Documents

13.3 Structure of Health Care Transactions

13.4 Health Care Corporate Structures

13.5 Key Issues In Structuring Transactions

13.6 Unwinding Transactions

13.7 Types of Health Care Contracts

13.8 Termination of Agreements

13.9 Current Climate of Health Care Transactions and Contracting

Chapter 14 Dispute Resolution

14.1 Introduction

14.2 Arbitration

14.3 Mediation

14.4 Conflict Management

14.5 The Government’s Role In Health Care

14.6 Conclusion

Glossary

Index