Regulatory Resources

Your Source for Keeping Up with Healthcare Regulations

There is nothing simple about the U.S. healthcare system.  We have a literal alphabet soup of regulations, payment reforms and requirements.  We provide an index of available content to the right. So let's use this space to a glossary and index to the major ones with linkage to relevant content:

Accreditation - Healthcare organizations participate  in a third-part audit process in to demonstrate the ability to meet predetermined criteria and standards  established by a professional accrediting agency. The three major hospital accreditation agencies in the U.S. are the Joint Commission (TJC), the Accreditation Commission for Health Care (ACHC) and DNV-GL. In addition to these, several agencies also accredit organizations such as ambulatory clinics, hospices and ambulatory surgical centers.

CMS (Centers for Medicare and Medicaid)  - CMS is the agency within the United States federal government which oversees the Medicare and Medicaid programs.  Medicare provides coverage for individuals aged 65 and older and those on disability.

COP (Conditions of Participation) - CMS publishes their Conditions of Participation and Conditions of Coverage for at the CMS.gov website. They publish various rules and regulations which they apply to healthcare organizations that accept CMS payments.  Providers of health care are responsible to understand and comply to the COP's that apply to their market segment. Most relate to improving outcomes and patient safety. Accreditation agencies also include these standards in their audits of healthcare organizations.

MACRA (the Medicare Access and CHIP Reauthorization Act of 2015) - Congress passed MACRA in 2015 and enacted it in January 2017.  This law creates the Quality Payment Program (QPP) that creates bonuses and penalties for doctors (and mid-level providers) for their efforts toward use of electronic records, process improvement programs and cost containment.

PAMA (the Protecting Access to Medicare Act of 2014) - PAMA creates new CMS requirements for the ordering of advanced imaging (e.g. CT, PET and MRI Scans), selective laboratory testing and cardiac testing to define appropriate ordering of high cost tests.

QPP (Quality Payment Program) - see MACRA above.

This list will be updated over time and does not reflect every U.S. healthcare regulation.

Learn more about MACRA and the Quality Payment Program