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AHIP AHM-510 Governance and Regulation Exam Practice Test

Demo: 11 questions
Total 76 questions

Governance and Regulation Questions and Answers

Question 1

States may impose nominal deductibles, coinsurance, or copayments on some Medicaid recipients for certain services. Services for which states can require copayments from Medicaid recipients include:

Options:

A.

Emergency services

B.

Family planning services

C.

Both A and B

D.

A only

E.

B only

F.

Neither A nor B

Question 2

The Wentworth Corporation uses a self-funded plan to provide its employees with healthcare benefits. One consequence of Wentworth's approach to providing healthcare benefits is that self-funding

Options:

A.

Requires that Wentworth self-administer its healthcare benefit plan

B.

Requires that Wentworth pay higher state premium taxes than do insurers and health plans

C.

Eliminates the need for Wentworth to pay a risk charge to an insurer or health plan

D.

Increases the number of benefit and rating mandates that apply to Wentworth's plan

Question 3

The Sawgrass Health Center is an institution that trains healthcare professionals and performs various clinical and other types of healthcare-related research. Because Sawgrass receives government funding, it is required to provide medical care for the poor. Of the following types of health plans, Sawgrass can best be described as:

Options:

A.

A medical foundation

B.

An academic medical center (AMC)

C.

A healthcare cooperative

D.

A community health center (CHC)

Question 4

Antitrust laws can affect the formation, merger activities, or acquisition initiatives of a health plan. In the United States, the two federal agencies that have the primary responsibility for enforcing antitrust laws are the

Options:

A.

Internal Revenue Service (IRS) and the Department of Justice (DOJ)

B.

Office of Inspector General (OIG) and the Department of Defense (DOD)

C.

Federal Trade Commission (FTC) and the Department of Labor (DOL)

D.

Federal Trade Commission (FTC) and the Department of Justice (DOJ)

Question 5

Greenpath Health Services, Inc., an HMO, recently terminated some providers from its network in response to the changing enrollment and geographic needs of the plan. A provision in Greenpath's contracts with its healthcare providers states that Greenpath can terminate the contract at any time, without providing any reason for the termination, by giving the other party a specified period of notice.

The state in which Greenpath operates has an HMO statute that is patterned on the NAIC HMO Model Act, which requires Greenpath to notify enrollees of any material change in its provider network. As required by the HMO Model Act, the state insurance department is conducting an examination of Greenpath's operations. The scope of the on-site examination covers all aspects of Greenpath's market conduct operations, including its compliance with regulatory requirements.

The contracts between Greenpath and its healthcare providers contain a termination provision known as

Options:

A.

An 'economic credentialing' termination provision

B.

A 'breach of contract' termination provision

C.

A 'fair procedure' termination provision

D.

A 'without cause' termination provision

Question 6

The Tidewater Life and Health Insurance Company is owned by its policy owners, who are entitled to certain rights as owners of the company, and it issues both participating and nonparticipating insurance policies. Tidewater is considering converting to the type of company that is owned by individuals who purchase shares of the company's stock. Tidewater is incorporated under the laws of Illinois, but it conducts business in the Canadian provinces of Ontario and Manitoba.

With regard to the state in which Tidewater is domiciled, it is correct to say that, from the perspective of both Ontario and Manitoba, Tidewater is considered to be the type of corporation known as:

Options:

A.

A foreign corporation

B.

An alien corporation

C.

A sister corporation

D.

A domestic corporation

Question 7

Regulatory and legislative bodies are among the important environmental forces in the health plan industry. The following statements are about such regulation and legislation. Select the answer choice that contains the correct statement.

Options:

A.

Federal guidelines exist to direct health plans on compliance issues when a health plan encounters conflicting state laws in a given service area.

B.

Administrative rules and regulations do not carry the force of law.

C.

As stakeholders in the health plan industry, federal and state governments exert tremendous influence over a health plan's formation and operations.

D.

In recent years, the number of health plan bills in the state and the federal legislatures has decreased.

Question 8

Antitrust laws can affect the formation, merger activities, or acquisition initiatives of a health plan. In the United States, the two federal agencies that have the primary responsibility for enforcing antitrust laws are the

Options:

A.

Internal Revenue Service (IRS) and the Department of Justice (DOJ)

B.

Office of Inspector General (OIG) and the Department of Defense (DOD)

C.

Federal Trade Commission (FTC) and the Department of Labor (DOL)

D.

Federal Trade Commission (FTC) and the Department of Justice (DOJ)

Question 9

The Balanced Budget Act (BBA) of 1997 created the Medicare+Choice plan. One provision of the BBA under Medicare+Choice is that the BBA

Options:

A.

Requires health plans to qualify as either a competitive medical plan (CMP) or a federally qualified HMO in order to participate in the Medicare program

B.

Eliminates funding for demonstration projects such as the Medicare Enrollment Demonstration Project

C.

Narrows the geographic variations in payments to Medicare health plans by lowering the growth rate of payments in high-payment counties and raising the rates in low-payment counties

D.

Increases Graduate Medical Education (GME) payments to hospitals for the training and cost of educating and training residents

Question 10

The Surrey Medical Supply Company was formed as a limited partnership. In this partnership, Victoria Lewin is one of the limited partners and Oscar Gould is a general partner. This information indicates that, with respect to the typical characteristics of limited partnerships,

Options:

A.

Ms. Lewin has more freedom to opt out of the partnership than does Mr. Gould

B.

Ms. Lewin has more liability for the debts of Surrey than does Mr. Gould

C.

both Ms. Lewin and Mr. Gould participate in the day-to-day management of Surrey

D.

the partnership will continue upon the death of Mr. Gould, whereas it will end with the death of Ms. Lewin

Question 11

The Tidewater Life and Health Insurance Company is owned by its policy owners, who are entitled to certain rights as owners of the company, and it issues both participating and nonparticipating insurance policies. Tidewater is considering converting to the type of company that is owned by individuals who purchase shares of the company's stock. Tidewater is incorporated under the laws of Illinois, but it conducts business in the Canadian provinces of Ontario and Manitoba.

Tidewater established the Diversified Corporation, which then acquired various subsidiary firms that produce unrelated products and services. Tidewater remains an independent corporation and continues to own Diversified and the subsidiaries. In order to create and maintain a common vision and goals among the subsidiaries, the management of Diversified makes decisions about strategic planning and budgeting for each of the businesses.

By combining under Diversified a group of businesses that produce unrelated products and by consolidating the management of the businesses, Tidewater has achieved the type(s) of integration known as

Options:

A.

Conglomerate integration and operational integration

B.

Horizontal integration and operational integration

C.

Horizontal integration and virtual integration

D.

Conglomerate integration only

Demo: 11 questions
Total 76 questions