Question

Discuss the key legal and regulatory issues in government entitlement programs that affect health plans

Answer 1

Government entitlement programs are government benefits or services entitled to citizens and certain non-citizens satisfying eligibility conditions set by the legislation. Examples of government entitlement programs that affect health plans are Medicaid and Medicare. There are many key legal and regulatory issues in government entitlement programs that affect health plans. Often it is difficult to predict the number of beneficiaries and thus it becomes quite difficult to predict the total cost to the government during the drafting of bills for any fiscal year. The amount of money required for any fiscal year becomes difficult to predict. There is also the case of dual-eligibles who makes it difficult to calculate the amount. Often times it becomes difficult to have an economic and clinical balance for these entitlement programs. Trying to create balance leaves a dramatic impact on the care provided and clinical practice. Legal/regulatory dilemmas regarding reimbursements and standards of practice also need to be dealt with to get the desired benefits from these programs. Lack of diligence in gauging and following emerging rules and regulatory guidelines would result in a catastrophe with doubts in the existing system. Any legal updates regarding these entitlement programs need to the followed without any delay to avoid any discrepancies.