National health plan

Healthcare Policy and Regulations - National Health Coverage Plans, Reimbursements, and Quality

Description: The baccalaureate-graduate nurse will compare the benefits and limitations of major

forms of reimbursements on the delivery of health care services, advocate for vulnerable populations,

and describe how health care is organized and financed, including system cost factors.

Component: Essential V

Area Gold Mastery

Silver Acceptable

Bronze Developing

Unacceptable

purpose and importance of healthcare coverage

Describes the purpose and the importance of healthcare coverage (insurance).

Describes the purpose but not the importance of healthcare coverage (insurance).

Mentions the purpose and the importance of healthcare coverage (insurance).

Does not address section

vulnerable populations

Discusses two ways healthcare coverage (insurance) would be beneficial (helpful) for vulnerable populations.

Discusses one way healthcare coverage (insurance) would be beneficial (helpful) for vulnerable populations.

Mentions one or two ways healthcare coverage (insurance) would be beneficial (helpful) for vulnerable populations.

Does not address section

Medicare Describe the purpose and importance of Medicare. Support your position by describing how you agree with or disagree with the purpose of the plan.

Describe the purpose or importance of Medicare. Support your position by describing how you agree with or disagree with the purpose of the plan.

Describe the purpose and importance of Medicare. Does not support your position by describing how you agree with or disagree with the purpose of the plan.

Does not address section

coverage options

Summarizes two coverage options that facilitates access to care and summarizes two coverage options that limits access to care for the patient. Provides details.

Summarizes one coverage option that facilitates access to care and summarizes one coverage options that limits access to care for the patient. Provides details.

Summarizes one or two coverage options that facilitates access to care and summarizes one or two coverage options that limits access to care for the patient. Does not provide details.

Does not address section

Medicaid Describe the purpose and importance of Medicaid. Support your position by describing how you agree with or disagree with the purpose of the plan.

Describe the purpose or importance of Medicaid. Support your position by describing how you agree with or disagree with the purpose of the plan.

Describe the purpose and importance of Medicaid. Does not support your position by describing how you agree with or disagree with the purpose of the plan.

Does not address section

coverage options

Summarizes two coverage options that facilitate access to care and summarizes two coverage options that limit access to care for the patient. Provides details.

Summarizes one coverage option that facilitate access to care and summarizes one coverage option that limit access to care for the patient. Provides details.

Summarizes one or two coverage options that facilitate access to care and summarizes one or two coverage options that limit access to care for the patient. Does not provide details.

Does not address section

Diagnosis Related Groups

Describes the purpose of Diagnosis Related Groups (DRGs). Explains the impact of DRG’s on length of stay and payment of services. Discusses how payments for DRGs are now impacted by quality of care.

Completes two of three- 1) Describes the purpose of Diagnosis Related Groups (DRGs). 2) Explains the impact of DRG’s on length of stay and payment of services. 3) Discusses how payments for DRGs are now impacted by quality of care.

Completes one of three- 1) Describes the purpose of Diagnosis Related Groups (DRGs). 2) Explains the impact of DRG’s on length of stay and payment of services. 3) Discusses how payments for DRGs are now impacted by quality of care.

Does not address section

charity care Describes the role of charity care within an acute care health facility (hospital). Discusses how vulnerable populations and the uninsured are helped (impacted) from the charity care provided by health care facilities (hospitals). Explains how charity care can benefit the facility.

Completes two or three- 1) Describes the role of charity care within an acute care health facility (hospital). 2) Discusses how vulnerable populations and the uninsured are helped (impacted) from the charity care provided by health care facilities (hospitals). 3) Explains how charity care can benefit the facility.

Completes one of three- 1) Describes the role of charity care within an acute care health facility (hospital). 2) Discusses how vulnerable populations and the uninsured are helped (impacted) from the charity care provided by health care facilities (hospitals). 3) Explains how charity care can benefit the facility.

Does not address section