Domain 5 - Ethical, Legal, and Practice Standards

Question 1

Ethics

Answer 1

A universally accepted set of rules of behavior based on ideas of what is considered right and wrong that are adopted by a group of people

Question 2

What are the 7 Ethical Principles for Case Managers?

Answer 2

1. Autonomy: independence or freedom, as of the will or one’s actions
2. Privacy/Confidentiality
3. Veracity: truthfulness
4. Beneficence: doing things to benefit others (duty to do good)
5. Nonmaleficence: refraining from doing things that could harm others (avoid harm)
6. Justice: fair treatment
7. Fidelity: honor commitments

Question 3

What is the difference between nonmaleficence and beneficence?

Answer 3

Beneficence means performing a deed that benefits someone, while nonmaleficence means refraining from doing something that harms or injures someone.

Feeding people at a soup kitchen is an example of beneficence. Preventing a patient from taking a harmful medication is an example of nonmaleficence.

Question 4

What is the Ethical Decision-Making Model used for?

Answer 4

To help resolve ethical dilemmas. The model should be used to make sure you are informed of all the sides to the issue and you do not allow any personal feelings or biases to become involved.

Question 5

Emergency Medical Treatment and Labor Act (EMTALA) (1986)

Answer 5

States that any person who presents themselves at an emergency department in need of treatment MUST be treated regardless of their ability to pay, hospitals cannot turn anyone away if they need treatment, and they must stabilize any person before they can be transferred to another facility

Question 6

EMTALA

Answer 6

Emergency Medical Treatment and Labor Act (EMTALA) (1986)

Question 7

HIPAA

Answer 7

Health Insurance Portability and Accountability Act (HIPAA)

Question 8

PHI

Answer 8

Protected Health Information

Question 9

Health Insurance Portability and Accountability Act (HIPAA)

Answer 9

HIPAA covers how medical information is used and disclosed. This information is
called protected health information (PHI).

Protects an individual’s personal and health information and it also covers the rights an individual has for obtaining access to their medical (or their children’s) information and for making corrections to that information.

Question 10

HIPPA Privacy Rule

Answer 10

Limits use of individually identifiable personal health information

Question 11

HIPPA Security Rule

Answer 11

Established national standards for securing client data that is stored or transferred electronically

Question 12

There are exceptions to HIPPA where there is no authorization required, which includes:

Answer 12

• Public health
• Abuse, Neglect, domestic violence
• Court order signed by a judge
• Response to a HIPAA Investigation Subpoena (different from a state lawsuit subpoena)

Question 13

The Patient Protection and Affordable Care Act of 2010 (PPACA) (also referred to as ACA), ensures:

Answer 13

Ensures that clients:
-Have autonomy, and can make their healthcare decisions without interference
-Are provided with the ability to give informed consent
-Receive respectful care and treatment
-Are able to complain about deviations from established care standards without fear of reprisal

Question 14

Social Security Act

Answer 14

• Enacted in 1935 – provided benefits for the aged, blind, dependent, and crippled children, maternal/child health, and old-age benefits.
• Amendments to the act in 1965 gave us legislation in which the most important provisions resulted in creation of Medicare and Medicaid

Question 15

Title XVIII

Answer 15

Title XVIII – Medicare
* Medical care for those over 65 and disabled persons entitled to Social Security benefits

Question 16

Title XVIX

Answer 16

Title XVIX – Medicaid
* Provided for health care for the indigent and other designated groups
* Jointly funded by federal and state governments
* Criteria vary from state to state

Question 17

Occupational Safety and Health Act 1970 (OSHA) primary goal is:

Answer 17

• Reduce workplace hazards
• Implement safety and health programs for employers and employees

Question 18

Occupational Safety and Health Act 1970 (OSHA) Employee Rights

Answer 18

• Obtain clear information about workplace hazards
• Review documentation on work-related injuries and illnesses
• Make confidential complaint
• Freedom from retaliation for complaints or inquiries

Question 19

Definition of Case Management

Answer 19

Case Management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote patient safety, quality of care, and cost-effective outcomes.

Question 20

Patient Self-Determination Act 1990 (PSDA)

Answer 20

• Amendment to titles XVIII and XIX of the Social Security Act
• Requires hospitals, skilled nursing facilities, home health agencies, hospice programs, and health maintenance organizations (HMOs) to:
  -Inform clients of their rights under State law to make decisions concerning their medical care
  -Periodically inquire as to whether a client executed and advanced directive and document the client’s wishes regarding their medical care
  -Not discriminate against persons who have executed an advance directive
  -Ensure that legally valid advance directives and documented medical care wishes are implemented to the extent permitted by State law
  -Provide educational programs for staff, clients, and the community on ethical issues concerning client self-determination and advance directives

Question 21

What is the difference between Self-Determination and Autonomy?

Answer 21

• Autonomy – freedom from external control or influence; personal liberty
  -Can refuse or terminate care
• Self-determination – the process by which one controls their own life and make treatment decisions including:
  -Designate healthcare proxy
  -Establish advance directives
  -Refuse or discontinue care, life support, nutritional support

Question 22

Informed Consent

Answer 22

A person’s agreement to allow something to happen, made with full knowledge of the risks involved and the alternatives.

Question 23

Advance Directive

Answer 23

A written statement of a person’s wishes regarding medical treatment, often including a living will, made to ensure those wishes are carried out should the person be unable to communicate them to a doctor

Question 24

Living Will

Answer 24

Health care declaration of what the individual wants, or does not want done, medically if they become too ill or injured to direct care

Question 25

Durable Medical Power of Attorney for Health Care (DPOA) (POA)

Answer 25

Appointment of another person to make medical decisions when they are unable to make them
themselves.

• Durable POA means that the document is valid if the individual is deemed incompetent or lacking capacity to make decisions
• POA documents may be limited based on the type (general, special, healthcare)
• A durable POA can only be revoked if the client has capacity, or by a court appointed conservator if the individual is lacking capacity
• May also be known as a Health Care Proxy

Question 26

DNR/DNI

Answer 26

DO NOT RESUSCITATE/DO NOT INTUBATE (DNR/DNI)

Question 27

DO NOT RESUSCITATE/DO NOT INTUBATE (DNR/DNI)

Answer 27

A written physicians order, based on the wishes of the individual or decision maker, not to
resuscitate and/or intubate should the individual stop breathing

Question 28

POLST

Answer 28

PHYSICIAN ORDERS FOR LIFE SUSTAINING TREATMENT (POLST)

Question 29

PHYSICIAN ORDERS FOR LIFE SUSTAINING TREATMENT (POLST)

Answer 29

• It is a bridge between an advance directive and direct intervention
• Most states print them on bright neon paper
• Usually recommended to be kept on the refrigerator
• May become part of the hospital record when admitted

Question 30

Clinical Capacity

Answer 30

Clinical capacity to make health care decisions is the ability to understand the benefits and risks of the proposed health care, to understand possible alternatives, and to make and communicate a health care decision.

Assessment of this capacity requires evaluation of the following:
* Medical factors (e.g., the client’s medical condition, sensory deficits, drug side effects, emotional and psychiatric issues)
* Functional abilities (physical, cognitive, and psychologic)
* Environmental factors (e.g., risks, supports, impediments to capacity)

Question 31

Competency (Legal Incapacity)

Answer 31

The mental ability and capacity to make decisions, accomplish actions, and perform tasks that any human being would be reasonably expected to
perform adequately.

• Competency is a legal judgment rendered by a Court after hearing evidence.
• If capacity is an issue, the family may need to have competency decided legally through a court competency hearing. Only the court can declare a person to be legally incompetent.

Question 32

The Hierarchy of Law

Answer 32

Federal laws and regulations preempt or supersede state law (Doctrine of Supremacy). State law supersedes local law. But in the absence of federal law, or when a state law would provide more protections for consumers, employees, and other residents than what is available under existing federal law, state law holds.

Question 33

Negligence

Answer 33

Negligence is failure to exercise reasonable care that results in damage or harm to another person.

Question 34

What is the Quadruple Aim?

Answer 34

Enhancing patient experience, improving provider work life, reducing cost, improving population health.

The Triple Aim focuses on enhancing the client experience, improving population health, and reducing costs which is widely accepted to optimize health system performance.

The Quadruple Aim adds the goal
of improving the work life of health care providers, including clinicians and
staff