Regulation

A rule or order of an agency made under the authority of a statute enacted by the legislature.


The intervention of government in the health care or health insurance market to control entry into or change the behavior of participants in that marketplace through specification of rules for the participants. This does not usually include programs which seek to change behavior through financing mechanisms or incentives. It also does not include private accreditation programs although they may be relied upon by government regulatory programs, as is the Joint Commission on Accreditation of Hospitals under Medicare. Regulatory programs can be described in terms of their purpose (control charges), who is regulated (hospitals), who regulates (State government), and method (prospective rate review). Regulatory programs include some certification, some registration, licensure, certificate of need, and the ESP, MAC and FSRO programs. Also, a synonym for a rule published by the executive branch of the Federal government implementing a law.


The act of regulating.


A rule or procedure made by a governmental agency, and having the force of law, as contrasted with an administrative guideline , which is merely advisory.


 


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