The important health care regulations in the US

We are now accustomed to lawmakers getting themselves involved in construction and polishing health care regulations and laws. Whether it be on a federal, state, or local level of governance, most of them would like to have a say on what rules should be imposed on the health and welfare of the people. Here are some of the most important health care regulations that the US has devised to manage and control healthcare and the public’s well-being. For more information, read at https:/


Health care regulations in the US



The Health Insurance Portability and Accountability Act of 1996 is designed to protect a piece of patient information and maintain its confidentiality. The usage, storage, maintenance and transmittal of a patient’s health information should be done in a way that complies with the rules of HIPAA. The US government headed by the Department of Health and Human Services came up with rules and regulations on how to use or give away any health record (medical, dental, psychological, etc.) boundaries and limitations were imposed to make sure that any medical professional should take extra care of any information related to their patient, whether it be in the form of verbal, written, or electronic records. Because more and more medical institutions and doctors are using outsourced business processes, these offshore companies and employees should all follow these rules and regulations or else they will all be up for criminal and civil investigation and penalties. Examples of records that are included in the regulation, aside from health records, are the following:

  • Prescriptions
  • Billing
  • Transcript of patient visit (electronic)
  • Imaging results


HIPAA regulations

The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 came about because the coverage of HIPAA is a bit lacking when it comes to electronic health information safekeeping.  This act became the sword and shield of HIPAA. It orders all healthcare companies to audit their standards and services if these are in compliance with the health care regulation and rules mandated by HIPAA. This act helped healthcare providers transition from physical to electronic health records (EHR) and imposed stronger data security requirements for them to follow. This ensures that if a privacy or confidentiality breach happens, both the healthcare provider and all their business associates will be up for investigation and penalties, even legal consequences. Monetary penalties have reached millions of dollars for every year that they have violated any health care regulation.


The Medicare Access & Children’s Health Insurance Program Reauthorization Act of 2015 (MACRA) covers and regulates the doctors’ fees and cost management for Medicare Part B. for those who do not know Medicare Part B, it is a part of the Medicare plan that includes the coverage of medical necessities and preventive services. Examples of these are the use of DMEs or durable medical equipment, cost of clinical research, mental health consultation or hospitalization, ambulance services, and cost of some prescription drugs.


Medical necessity

Speaking of medical necessity, this is also a topic that the US government wants to get their hands on. They regulated the meaning of what is ‘medically necessary’, and advises all patients and health providers that any procedure deemed not necessary for a patient’s welfare will not be shouldered by the government (either by Medicare or Medicaid).


These are just some of the health care regulations that the US imposes to make sure that the health and welfare of its citizens and safeguarded and properly delivered.


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