Course Syllabus
LSH 6123 - Regulation of Private Health Insurance, Managed Care, and the Effects of the ACA!
Professor Contact Information
Course Details
For a list of course activities, scroll to the bottom of this page.
Course Description
This course will cover the regulation of health insurance companies with a focus on changes brought about by the Affordable Care Act (ACA). Students will become familiar with managed care concepts and analyze key components of health care plans.
Course Delivery
Synchronous and Asynchronous Online: Learning occurs online and in real-time, using technology such as web-conferencing software for synchronous Live Sessions and discussion boards, assignments, pre-recorded lectures, assigned readings, and other activities for asynchronous engagement. This course is delivered across a 7-week semester with (3) 60-minute Live Sessions throughout the course.
Course Prerequisites
Admission to the Master of Legal Studies and/or Master of Laws Programs
Course Materials
Kongstvedt, P. R. (2020). Health insurance and managed care: What they are and how they work. Fifth edition. Burlington, MA: Jones & Bartlett Learning. ISBN: 9781284152098
Program Learning Outcomes (PLO)
- Compare and contrast the legal and regulatory framework of the public and private systems for financing the purchase of healthcare systems
- Examine the different relationships at the healthcare enterprise level and within enterprises
- Apply the rules and best practices governing the quality of healthcare
- Navigate the rules and practices governing fair and accurate billing for healthcare
- Analyze the rules and practices relating to health information and privacy protection
Course Learning Outcomes (CLO) Alignment
| CLO | Description | PLO |
|---|---|---|
| A |
Examine the evolution of the health insurance system and managed care in the United States by:
|
1 |
| B |
Analyze the core components of health plan coverage by:
|
2 |
| C |
Identify the basic elements of payer-provider contracts by:
|
2 & 3 |
| D |
Identify the difference between payment and reimbursement by:
|
4 |
| E |
Identify the basic components of utilization management by:
|
2 & 4 |
| F |
Identify the basic structure and governance of payer organizations by:
|
2 & 5 |
| G |
Discuss key state and federal laws governing health insurance by:
|
1 |
Grades
Breakdown
| Activity | Description | Percentage |
|---|---|---|
| Live Session Participation | Attendance and participation in 3 of the Live Session offerings. Alternative assignments are offered for those who canot attend in real-time. | 5% |
| Discussions | Weekly discussion board assignments | 15% |
| Quizzes | Weekly quizzes | 10% |
| Written Assignments | React Exercises (written essays) will be scheduled for all units. | 20% |
| Midterm Exam | 50 questions of various types from Units 1-4. | 25% |
| Final Exam | 50 questions of various types from Units 5-7 | 25% |
| Total | 100% |
Scale
This course will be graded on a 12-point scale.
| Points | Letter Grade | Percentage of Points |
|---|---|---|
| 12 | A+ | 100%-97% |
| 11 | A | 96%-94% |
| 10 | A- | 93%-90% |
| 9 | B+ | 89%-87% |
| 8 | B | 86%-84% |
| 7 | B- | 83%-80% |
| 6 | C+ | 79%-77% |
| 5 | C | 76%-74% |
| 4 | C- | 73%-70% |
| 3 | D+ | 69%-67% |
| 2 | D | 66%-64% |
| 1 | D- | 63%-60% |
| 0 | F | 59% or below |
Course Components
Assigned Readings
Readings will be assigned from the required textbook and some supplemental materials for each unit. These items will provide background knowledge of the key concepts and terminology applicable to each unit of the course.
Lectures
The assigned videos will expand on concepts in the course reading requirements
Live Session Participation
During Unit 1 there will be an introductory session to review getting started for Unit 1 and the course. Other live sessions will be scheduled in Unit 4 for Midterm Exam preparation and Unit 7 for Final Exam preparation.
Note: More details can be found in the “Zoom Conferences” page in the Getting Started module.
Discussions
Weekly discussion boards requiring an initial response by Midnight on Thursdays and responses by Midnight on Sundays each week. The initial post does require a citation.
Quizzes
Course quizzes are intended to test comprehension or ability to apply the rules where the issues, for topics that might be more straightforward or for which there aren’t cases or other materials to work through or discuss.
Written Assignments
Essays of 2-3 pages are assigned in every unit to reinforce the learning objectives from the textbook and videos. Some essays/assignments may require additional research to identify applicability of the state law in the student’s residence or current articles discussing the topics addressed in a Unit.
Midterm Exam
The midterm exam will cover content from Units 1-4 and consist of:
- 20 - True/False Questions,
- 20 - Multiple Choice, and
- 2 - Short Essay Questions.
Note: You will have 3 hours to complete the midterm exam.
Final Exam
The final exam will cover content from Units 5-7 and consist of:
- 20 - True/False Questions,
- 20 - Multiple Choice, and
- 2 - Short Essay Questions
Note: You will have 3 hours to complete the final exam.
Course Policies
Communication
Please do not hesitate to contact me or the course facilitator if you have a question, will be late with an assignment or if an emergency or life circumstance will impact your performance in the class.
You should contact me at my OU email, Teresa.A.Williams-1@ou.edu
Canvas has an email option and you may use it as well. You should address the email to both your professor and the course facilitator. I typically respond within 24 hours M-F. Emails received over the weekend may have a 48 hour response time. If you have an emergency, you may text me at 405-830-0806. Note: Please utilize the text message option only for true emergencies.
Feedback
Most assignments will have a one-week turnaround time for grading. Your
Midterm and Final Exams contain short answer and essay questions which must be manually graded, so these exams may take slightly longer. Also, I generally do not release the Midterm and Final Exam scores until everyone in the course has turned in their exam. If a student is late turning in these exams, it may impact the timing of the grade release.
Late Policy
You should strive to turn your assignments in on time. Late work is generally not accepted at the graduate level, You should contact your professor and course facilitator immediately, preferably before a deadline is missed if feasibly possible, if extenuating circumstances arise. Late penalties may apply if the professor has not granted an extension for extenuating circumstances.
Absent prior permission by the professor, if a student fails to submit all course work by the last day of the course, the professor may choose from among the following options:
- calculate the final grade giving no credit for missing work;
- allow (if circumstances warrant) a short extension of time that still permits the professor to submit grades on time;
- or (if circumstances warrant), give the student an “Incomplete” by following the OU procedures for Incomplete grades.
Generative AI Policy
🚩🚩 (required component, text may vary and could be included, as long as it is explicit, in Academic Integrity Language)
In addition to syllabus policy language, you are encouraged to have Generative AI policies for each assignment in your class. This level of discussion about Generative AI will help reduce confusion among students about what is appropriate versus inappropriate usage. Even if you choose to implement a Generative AI ban, explaining how Generative AI could, but shouldn’t, be used, and why, on specific assignments, will help students navigate a digital environment in which Generative AI is increasingly integrated into search tools, e-books, Microsoft and Google products, etc. For examples of assignment policies and more, please visit CFE’s Generative AI course.
Five policy examples are provided based on the AI Assessment Scale (Perkins, Furze, Roe, and MacVaugh 2024), and a sixth that indicates that the policy will change depending on the specific assignment. The AI Assessment Scale was intended to be used for policy guidance on individual assessments, but may also be used across your course, if appropriate. You may also want to mix and match the sample statements to more closely align with your course goals and pedagogical approach. Please view the AI Policy Examples page for details and verbiage about each policy example. 🚩🚩
Plagiarism
There is no college-level assignment that can be satisfactorily completed by copying. OU's basic assumption about writing is that all written assignments show the student's own understanding in the student's own words. That means all writing assignments, in class or out, are assumed to be composed entirely of words generated (not simply found) by the student, except where words written by someone else are specifically marked as such with proper citation. Including other people's words in your paper is helpful when you do it honestly and correctly. When you don't, it's plagiarism.
For more information about plagiarism, watch the OU Libraries Plagiarism Tutorial video and take the short Avoiding Plagiarism Tutorial Canvas course offered by University Libraries.
University Academic Policies and Student Support
Access the University Academic Policies Document.
Course Summary:
| Date | Details | Due |
|---|---|---|