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Question 1

The Zephyr Health Plan identifies members for whom subacute care might be an appropriate treatment option. The following individuals are members of Zephyr:

Selena Tovar, an oncology patient who requires radiation oncology services, chemotherapy, and rehabilitation.

Dwight Borg, who is in excellent health except that he currently has sinusitis.

Timothy O'Shea, who is beginning his recovery from brain injuries caused by a stroke.

Subacute care most likely could be an appropriate option for:

AMs. Tovar, Mr. Borg, and Mr. O'Shea

BMs. Tovar and Mr. O'Shea only

CMr. O'Shea only

DMr. Borg only

Correct : B

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AMs. Tovar, Mr. Borg, and Mr. O'Shea

BMs. Tovar and Mr. O'Shea only

CMr. O'Shea only

DMr. Borg only

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Question 2

The following statements are about network management for behavioral healthcare (BH). Three of these statements are true and one statement is false. Select the answer choice containing the FALSE statement.

ATwo measures of BH quality are patient satisfaction and clinical outcomes assessments.

BFor a health plan, one argument in favor of contracting with a managed behavioral healthcare organization (MBHO) is that the health plan's members can gain faster access to BH care.

CIn their contracts with health plans, managed behavioral healthcare organizations (MBHOs) usually receive delegated authority for network development and management.

DHealth plans generally compensate managed behavioral healthcare organizations (MBHOs) on an FFS basis.

Correct : D

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ATwo measures of BH quality are patient satisfaction and clinical outcomes assessments.

BFor a health plan, one argument in favor of contracting with a managed behavioral healthcare organization (MBHO) is that the health plan's members can gain faster access to BH care.

CIn their contracts with health plans, managed behavioral healthcare organizations (MBHOs) usually receive delegated authority for network development and management.

DHealth plans generally compensate managed behavioral healthcare organizations (MBHOs) on an FFS basis.

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Question 3

The Omnibus Budget Reconciliation Act of 1986 (OBRA 1986) established the Programs of All-Inclusive Care for the Elderly (PACE). One characteristic of the PACE programs is that:

AThey are available to United States citizens only after they reach age 65.

BThey have an upper dollar limit.

CThey receive a monthly capitation that is set at 100% of the Adjusted Average Per Capita Cost (AAPCC).

DPACE providers receive capitated payments only through the PACE agreement.

Correct : D

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AThey are available to United States citizens only after they reach age 65.

BThey have an upper dollar limit.

CThey receive a monthly capitation that is set at 100% of the Adjusted Average Per Capita Cost (AAPCC).

DPACE providers receive capitated payments only through the PACE agreement.

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Question 4

The following statements are about Medicaid health plan entities. Select the answer choice containing the correct statement:

ATo keep Medicaid enrollment costs as low as possible, states typically prohibit the use of third-party entities known as enrollment brokers to handle the recruitment and enrollment of Medicaid recipients in health plan plans

BPrimary care case managers (PCCMs) are individuals who contract with a state's Medicaid agency to provide primary care services mainly to urban areas.

CTypically, Medicaid beneficiaries must be given a choice between at least two health plan entities.

DMedicaid health plan entities are responsible for providing primary coverage for all dually-eligible beneficiaries.

Correct : C

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BPrimary care case managers (PCCMs) are individuals who contract with a state's Medicaid agency to provide primary care services mainly to urban areas.

CTypically, Medicaid beneficiaries must be given a choice between at least two health plan entities.

DMedicaid health plan entities are responsible for providing primary coverage for all dually-eligible beneficiaries.

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Question 5

The two basic approaches that Medicaid uses to contract with health plans are open contracting and selective contracting. One true statement about these approaches to contracting is that:

AOpen contracting requires health plans to meet minimum performance standards outlined in a state's request for proposal (RFP)

BOpen contracting makes it possible for the Medicaid agency to offer enrollment volume guarantees

CSelective contracting requires any health plan that meets the state's performance standards and the federal Medicaid requirements to enter into a Medicaid contract

DSelective contracting requires health plans to bid competitively for Medicaid contracts

Correct : D

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AOpen contracting requires health plans to meet minimum performance standards outlined in a state's request for proposal (RFP)

BOpen contracting makes it possible for the Medicaid agency to offer enrollment volume guarantees

CSelective contracting requires any health plan that meets the state's performance standards and the federal Medicaid requirements to enter into a Medicaid contract

DSelective contracting requires health plans to bid competitively for Medicaid contracts

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Total 202 questions

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