A nurse is assisting with teaching a class about the roles and responsibilities of a case manager. Which of the following responsibilities should the nurse include?

Choice A reason: If client is uninsured the ED can decline to render services is not an information that the nurse should include in the teaching. This is a false statement that contradicts the purpose and the provision of EMTALA. According to EMTALA, any hospital that participates in Medicare and has an emergency department must provide an appropriate medical screening examination to anyone who requests it, regardless of their insurance status or ability to pay.
Choice B reason: The ED has the right to refuse to provide client services is not an information that the nurse should include in the teaching. This is a false statement that violates the principle and the requirement of EMTALA. According to EMTALA, any hospital that participates in Medicare and has an emergency department has a duty to provide stabilizing treatment to any individual who has an emergency medical condition or is in active labor, unless an appropriate transfer is arranged.

Choice C reason: The ED can transfer medically unstable clients to other facilities is not an information that the nurse should include in the teaching. This is a false statement that breaches the rule and the regulation of EMTALA. According to EMTALA, any hospital that participates in Medicare and has an emergency department must not transfer an individual who has an emergency medical condition or is in active labor, unless the transfer is requested by the individual or their representative, or the transfer meets certain criteria, such as the benefits outweigh the risks, the receiving facility has agreed to accept the transfer, and the transfer is effected by qualified personnel and equipment.
Choice D reason: Clients must receive a medical screening evaluation (MSE) is an information that the nurse should include in the teaching. This is a true statement that reflects the essence and the standard of EMTALA. According to EMTALA, any hospital that participates in Medicare and has an emergency department must provide an appropriate medical screening examination to anyone who comes to the emergency department and requests examination or treatment for a medical condition, to determine whether or not an emergency medical condition exists

Choice A reason: This statement is false and should not be included in the teaching. The Enforcement Rule does not address the use and disclosure of ePHI, which stands for electronic protected health information. The use and disclosure of ePHI is addressed by the Privacy Rule and the Security Rule, which are part of the HIPAA Administrative Simplification Rules.

Choice B reason: This statement is false and should not be included in the teaching. The Enforcement Rule does not cover the process of reporting data breaches, which are unauthorized or unlawful access, use, or disclosure of protected health information. The process of reporting data breaches is covered by the Breach Notification Rule, which is also part of the HIPAA Administrative Simplification Rules.

Choice C reason:This statement is false and should not be included in the teaching.The definition of protected health information (PHI) is outlined in the HIPAA Privacy Rule, not the Enforcement Rule. PHI includes any information about health status, provision of healthcare, or payment for healthcare that can be linked to an individual, whether in electronic, paper, or oral form. The Privacy Rule defines PHI and ePHI explicitly to establish what needs to be protected under HIPAA regulations. The Enforcement Rule does not define PHI but instead deals with the penalties and compliance actions when HIPAA rules, such as those defined in the Privacy or Security Rules, are violated.

Choice D reason:This statement is true and should be included in the teaching. The HIPAA Enforcement Rule explicitly covers the administration of financial penalties for violations of HIPAA regulations. It outlines the processes by which the Department of Health and Human Services (HHS) investigates potential violations, determines compliance failures, and imposes civil monetary penalties when necessary. The Enforcement Rule also establishes the structure of penalties based on factors such as the severity of the violation, whether the violation was willful or accidental, and whether corrective actions were taken promptly. This ensures accountability and compliance with HIPAA standards, making this the correct answer to the question.