AHM-510 무료 덤프문제 온라인 액세스

One provision of the Mental Health Parity Act of 1996 (MHPA) is that the MHPA prohibits group health plans from

• A.Setting a cap for a group member's lifetime medical health benefits that is higher than the cap for the member's lifetime mental health benefits
• B.Imposing limits on the number of days or visits for mental health treatment
• C.Imposing annual limits on the number of outpatient visits and inpatient hospital stays for mental health services
• D.Charging deductibles for mental health benefits that are higher than the deductibles for medical benefits

Regulators of health plans have set standards in a number of areas of plan operations.
Requirements with which health plans must comply typically include

• A.providing enrollees and prospective enrollees with detailed information about various aspects of health plan policies and operations
• B.all of the above
• C.maintaining quality assurance programs that reflect the plan's activities in monitoring quality
• D.maintaining internal grievance and appeals processes to resolve enrollee complaints against the organization

Arthur Dace, a plan member of the Bloom health plan, tried repeatedly over an extended period to schedule an appointment with Dr. Pyle, his primary care physician (PCP). Mr. Dace informally surveyed other Bloom plan members and found that many people were experiencing similar problems getting an appointment with this particular provider. Mr. Dace threatened to take legal action against Bloom, alleging that the health plan had deliberately allowed a large number of patients to select Dr. Pyle as their PCP, thus making it difficult for patients to make appointments with Dr. Pyle.
Bloom recommended, and Mr. Dace agreed to use, an alternative dispute resolution (ADR) method that is quicker and less expensive than litigation. Under this ADR method, both Bloom and Mr. Dace presented their evidence to a panel of medical and legal experts, who issued a decision that Bloom's utilization management practices in this case did not constitute a form of abuse. The panel's decision is legally binding on both parties.
Different types of compensation arrangements in managed care plans, from fee-for-service (FFS) arrangements to capitation arrangements, lead to different types of fraud and abuse. From the answer choices below, select the response that identifies the form of abuse in which Bloom is allegedly engaging, according to Mr. Dace's complaint, and whether this form of abuse is more likely to occur in FFS compensation arrangements or in capitation arrangements.

• A.Type of abuse underutilization Type of compensation arrangement FFS arrangement
• B.Type of abuse underutilization Type of compensation arrangement capitation arrangement
• C.Type of abuse overutilization Type of compensation arrangement capitation arrangement
• D.Type of abuse overutilization Type of compensation arrangement FFS arrangement

The following answer choices describe various approaches that a health plan can take to voice its opinions on legislation. Select the answer choice that best describes a health plan's use of grassroots lobbying.

• A.A representative of the Palmer Health Plan is attending a one-on-one meeting with a legislator to present Palmer's position on pending managed care legislation.
• B.The Delancey Health Plan is launching a media campaign in an effort to persuade the public that proposed health care legislation will increase the cost of healthcare.
• C.The Bestway Health Plan is encouraging its employees to contribute to a political action committee (PAC) that is funding the political campaign of a pro-health plan candidate.
• D.The Stellar Health Plan is using direct mail and telephone calls to encourage people who support a patient rights bill to contact key legislators and voice their support for the bill.

Solvency standards for Medicare provider-sponsored organizations (PSOs) are divided into three parts: (1) the initial stage, (2) the ongoing stage, and (3) insolvency. In the initial stage, prior to CMS approval, a Medicare PSO typically must have a minimum net worth of

• A.$1,000,000
• B.$2,000,000
• C.$750,000
• D.$1,500,000