Meeting Standards Paper
MHAD 6250 Health Services in the US
There is more to becoming a licensed professional than going to medical school and passing the board examination. For an aspiring physician in the state of Arizona, the Arizona State Legislature office has determined the following steps: graduate from an approved school of medicine, complete a twelve-month hospital internship, residency or clinical fellowship program, not be under investigation, suspension or restriction by the medical regulatory board, Health and Human Services Office of Inspector General, paid all fees, and submit a full set of fingerprints (A.R.S. Title 32, Chapter 13, Article 2. 1422- 25). Thankfully, after this process is complete, a physician just needs to remain licensed usually by completing continuing education classes and paying fees, unless (s)he decides to work with the underserved population through a State Medicaid agency or becoming board certified.
To become a license Medicaid provider and provide services to underserved populations, the process is slightly easier; however, becoming an AHCCCS provider does involve more government involvement. Following the successful application, each provider is assigned an AHCCCS Provider Number (APN) which is used for billing services. AHCCCS remains actively involved in the billing practices of their providers by authenticating claims data. By regulating claims, AHCCCS is ensuring that providers are not attesting to fraudulent claims. One of the many benefits of becoming an AHCCCS provider is becoming eligible for reimbursements programs that have become increasingly popular since the Affordable Care Act. While maintaining an active medical license is mandatory, some professionals decide to maintain other certifications which enhance their medical qualifications.
To be a board-certified physician demonstrates additional expertise in a specialized set of medicine. According to the American Board of Medical Specialties, having an additional certification “challenges physicians to focus on the continuous development of their skill set, especially those skills that enable them to function effectively in interprofessional teams, integrated systems of care, and community settings”. Initial certification is granted by passing written and oral examinations. Recertification occurs at seven-to ten-year intervals, although not all boards require recertification.
For an individual professional to continue their medical careers, they have to maintain accreditation by complying with Accreditation Council for Continuing Medical Education (ACCME). Participation in accredited CME helps physicians meet requirements for maintenance of licensure, maintenance of certification, credentialing, membership in professional societies, and other professional privileges.
Health care Facilities
Before any facility can even open their doors, they must be licensed by the Arizona Department of Health Services. An application for licensure or re-licensure shall be filed at least sixty but not more than one hundred twenty days before the anticipated operation or the expiration date of the current license. Arizona House Bill 21214 states: an application for a substantial compliance survey submitted pursuant to section 36?425, subsection G shall be filed at least thirty days before the date on which the substantial compliance survey is requested. While a license is necessary for the doors to open, the professional standards are maintained by certifications and accreditations.
The Joint Commission has accredited hospitals for more than 60 years. In 2001, The Joint Commission introduced its program to accredit critical access hospitals. In 2002, The Joint Commission obtained deemed status recognition for its critical access hospital accreditation program from the Centers for Medicare & Medicaid Services (CMS), allowing The Joint Commission to conduct both conversion (the initial survey to become a critical access hospital) and recertification surveys. Hospitals as well as other health care facilities also ensure compliance by having their staff regular maintain their certifications through continued education and training classes.
Hospitals that provide services to Medicaid patients are eligible for multiple reimbursement programs
The risk of health care facilities or their practitioners not maintaining their licenses, credentialing, or accreditation is failed performance standards and potentially human lives. The standards are not to be a bother; rather to ensure high performance standards are maintaining and improving patient safety and quality of care. If doctors with suspended medical licenses could provide care to their patients, there is a high risk for medical malpractice suits. Having the appropriate and UpToDate license, certification, and accreditation is not just for the professional or facility, it is a comfort to the patients who are looking for quality care.
A.R.S. Title 32, Chapter 13, Article 2. 1422- 25
H.R. 2124, Arizona 49th Cong. (2010) (enacted).
United States., Department of Health and Human Services., Office of Inspector General,.
(2016). CMS Is taking steps to improve oversight of provider-based facilities, but vulnerabilities remain.