State Regulations Deidra Manning HMGT 310 University Of Mary

State Regulationsdeidra Manninghmgt 310university Of Maryland Prof

State Regulations Deidra Manning HMGT 310 University of Maryland Professor Jerome Bozek November 29, 2015 Student Name: Deidra Manning Assignment #3 Title: Selection of a state regulation; The unannotated South Carolina Code of Regulations Agency Responsible: The South Carolina Legislative Council; The State Health and Human Services Finance Commission through the MEDICAID Incentives and Enforcement: The main enforcements are observed through ensuring that only the service providers enrolled in the program are the ones which provide the services, therefore enrollment is controlled and regulated Clients must be eligible for Medicaid to receive the services. The residents of South Carolina recipients of the services can be referred outside the South Carolina area, when this happens, they must have a prior approval from a state agency administering the Medicaid Program.

Technical assistance for the personnel providing the services is contained in the South Carolina State Plan for Title XIX (Medicaid), provider manuals, Medicaid Bulletins, and federal directives. This gives directives on their usage serving as a guide to their usage. Key Aspect of the Regulation #1: This regulation: Community Long Term Care Home and Community Based Services. It sets out clearly the requirements of the service receiver who should be a Medicaid eligible person, eighteen years of age or older, who has been determined by community long term care to require a skilled or intermediate level of care.this regulation has an effect on health care proffssional since they are required meet the said conditions. (2) Home delivered meals are the in home provision of at least one meal per day to persons unable to care for their nutritional needs.

This has a financial implication to the provider institution and making transport arrangements on availing the meals to the homes of the recipients. (3) Medical day care is a group of services to restore, maintain and promote the health status through the provision of ambulatory health care and health related supportive services in a licensed medical day care center. This group of services requires that systems be put in place to receive alerts of emergence and a response team which shall be on standby to attend to the emergencies as and when they arise. Medical social services are supportive services provided by an individual with no less than a Masters Degree in social work. The legal of academical training is essential to the personnel providing this service, because it is specific to the academical requirement of the said personnel Personal care is the in home provision of the necessary services in support of activities of daily living, home support, medical monitoring, and client transportation services to restore, maintain and promote health status.

This specifically affects the provider institution because special arrangements have to made to ensure adequate trained personnel to adequately manage the home provision of services. In terms of the equipments required they must be enough to serve nearly all served homes. Residential care is the provision of temporary institutional care for eligible clients living at home and cared for by their families or other informal support persons. This service will provide temporary relief for the primary care givers. The families and informal support persons must be given a basic training for service provision even if they are doing for a short time.

Service management includes assessment and reassessment, level of care of determination, service planning, service coordination, and counseling. This enables the providing institution to be efficient in service provision. Key Aspect of the Regulation #2: The regulation on Dental Care consists of any covered preventive, surgical, therapeutic and emergency dental service provided by a licensed dentist. Only emergency dental services are available for recipients age twentyone years and over. The person providing this service must be trained dentist and licensed, therefore the providing institution must acquire the right personnel for the same.

The insurance firms equally need to provide such a cover. Key Aspect of the Regulation #3: In the regulation of Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services. Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services are available to eligible Medicaid recipients from birth through the month they turn twentyone years of age. This program covers initial screening, periodic screening, diagnosis, and treatment. All services included in the Title XIX State Plan are available to those eligible. This cover has an age limit from birth to the month they turn twenty one years, therefore the clients in this category are the beneficiaries. Key Aspect of the Regulation #4: In the regulation on Hospital Services. A. Inpatient hospital services provided by the Medicaid Program are for the care and treatment of illness, injuries or disabilities certified medically necessary by a physician and reviewed for appropriateness of admission, length of stay and ancillary services, by the utilization review mechanism established by the State Health and Human Services Finance Commission. B. Outpatient hospital services sponsored by the Medicaid Program is ambulatory visits for the care and treatment of illness, injuries and disabilities certified as medically necessary by a physician. This does not include routine dental services. Therapy may be provided on an ambulatory basis as a continuing part of an inpatient stay. Key Aspect of the Regulation #5: Laboratory and Xray Services/Tests. Laboratory and xray services/tests must be ordered by a professional practitioner within the scope of his/her practice with the expectation of making a reasonable medical determination. Notated Copy of the Rules: Attach the copy of the regulation that you have marked up. Underline, highlight or note key sections. Mark them (1), (2), (3), etc. You may use technology to mark up in PDF or print, handwrite and scan the rules. Attach when you submit the assignment. Reference South Carolina Legislature. South Carolina Code of Regulations. Retrieved from Assignment #4. Roots of Organizational Policy The Comprehensive Final Project (Assignment #4) has been designed for the student to identify federal and state policy roots in a specific health services organization. The student will select a specific management area for a specific organization. The student will identify a health services setting where they have access to the policy manual (or a sample policy manual). The setting may include a single location or an organization with many types of services and many service delivery settings. Select one of the following spheres where you will map out and describe a minimum of five (5) organizational policies linked to federal or state legislative mandates. Note some policies may be required for accreditation and also related to public policy. This is the case with many NCQA standards. Prepare a final PowerPoint presentation with no more than 10-15 content slides. A cover and reference slide must be provided. Draw on what you have learned throughout the class including: a summary of each organizational policy and the federal/state legislative roots for each policy (by name and statute), any pending changes to the legislation, and your metrics for the organization in terms of performance. Health Management Areas (select one): · laboratory services ( Mayo Clinic, Mayo Medical Laboratories)

Paper For Above instruction

The regulation of Medicaid services in South Carolina exemplifies the intricate linkage between state policies and federal mandates that underpin healthcare delivery. These regulations are designed to ensure quality, safety, and accessibility of services while maintaining fiscal responsibility and compliance with legal standards. This paper critically examines the key components of South Carolina’s Medicaid regulations, their implications for healthcare providers, and the broader context of state and federal policy roots that shape these regulations.

Overview of South Carolina Medicaid Regulations

South Carolina’s Medicaid program is governed by regulations administered by the South Carolina Legislative Council and enforced through the State Health and Human Services Finance Commission. The core purpose of these regulations is to control provider enrollment, ensure client eligibility, and establish standards for a variety of healthcare services covered under Medicaid. Critical to this regulatory framework is the emphasis on service provision that aligns with federal requirements for Medicaid, particularly the CMS (Centers for Medicare & Medicaid Services) standards, which serve as the backbone for state policies (Kaiser Family Foundation, 2022).

Community Long Term Care and Home and Community-Based Services

The regulation covering community long-term care emphasizes that services such as home-delivered meals, personal care, medical day care, and residential care are contingent upon Medicaid eligibility and must meet specific care criteria. These standards ensure that services support independence and provide necessary medical and social support to enable individuals to remain in their homes (South Carolina Department of Health and Human Services, 2015). For example, home-delivered meals present logistical and financial challenges for providers, requiring transport arrangements and resource allocations. Similarly, medical day care centers must have protocols for emergency response, which aligns with federal guidelines on patient safety and quality assurance (Medicaid.gov, 2021).

Dental Care and EPSDT Programs

Dental care services are segmented into preventive, surgical, therapeutic, and emergency procedures, with the stipulation that providers be licensed dentists. This regulation underscores the importance of qualified personnel to meet federal licensure standards and ensure patient safety (American Dental Association, 2019). The EPSDT program, a critical component of Medicaid, provides comprehensive health screenings, diagnosis, and treatment for children and adolescents from birth to age twenty-one. This program historically aims to address health disparities, reduce long-term healthcare costs, and promote early intervention, thus reflecting the preventive ethos embedded in public health policy (U.S. Department of Health and Human Services, 2020).

Hospital and Laboratory Services

Inpatient and outpatient hospital services are also regulated to ensure that care is medically necessary and efficiently delivered. The utilization review process enforces compliance with federal standards, preventing unnecessary hospitalizations and promoting cost-effective care (Centers for Medicare & Medicaid Services, 2019). Laboratory and radiology services, critical for accurate diagnosis, require professional ordering within the scope of licensure, reinforcing standards for clinical decision-making and quality. These regulations embody the interdisciplinary and safety-oriented approach that characterizes modern healthcare regulation (HealthIT.gov, 2021).

Implications for Healthcare Providers and Policy Roots

These regulations inevitably affect healthcare providers by imposing licensure, staffing, and documentation standards, which ensure quality but can present operational challenges, especially for resource-limited organizations. The legal framework for Medicaid regulations in South Carolina is rooted in federal statutes such as the Social Security Act of 1935 (especially Title XIX), which established the Medicaid program, and subsequent amendments that refined provider and patient protections (CMS, 2022). State regulations implement these federal mandates by translating broad statutory language into specific operational procedures and standards.

Broader Context and Future Directions

The dynamic landscape of healthcare policy necessitates ongoing adaptation of state regulations. Pending legislative changes, such as efforts to expand Medicaid coverage or integrate emerging telehealth services, will influence future regulatory adjustments (National Conference of State Legislatures, 2023). Furthermore, performance metrics like patient satisfaction, service quality, and cost-efficiency remain vital indicators for assessing the effectiveness of these policies, guiding continuous improvement (Agency for Healthcare Research and Quality, 2020).

Conclusion

South Carolina’s Medicaid regulations exemplify how state policies operationalize federal mandates, ensuring that vulnerable populations receive essential healthcare services. These regulations serve as a foundation for quality assurance and access, balancing fiscal considerations with safety standards. Understanding the policy roots and future trajectory of Medicaid regulation underscores the importance of adaptive governance in complex healthcare systems, ultimately aiming to optimize health outcomes and system sustainability.

References

• American Dental Association. (2019). Recommendations for the Dental Team. ADA Publishing.
• Agency for Healthcare Research and Quality. (2020). National Healthcare Quality and Disparities Report. AHRQ.
• Centers for Medicare & Medicaid Services. (2019). Hospital Inpatient Prospective Payment Systems. CMS.
• Centers for Medicare & Medicaid Services. (2022). Medicaid State Health Official letter. CMS.
• HealthIT.gov. (2021). Improving Safety and Quality with Health Information Technology. HHS.
• Kaiser Family Foundation. (2022). Medicaid Policies and Spending. KFF.
• Medicaid.gov. (2021). State Medicaid Manual. CMS.
• National Conference of State Legislatures. (2023). Medicaid Policy Options & Reforms. NCSL.
• South Carolina Department of Health and Human Services. (2015). Medicaid State Plan. South Carolina.
• U.S. Department of Health and Human Services. (2020). Early and Periodic Screening, Diagnosis, and Treatment (EPSDT). HHS.