2017 Test Prep: Quiz 3

Question 1 / 8

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1. What does the 'R' mean?

The member can receive services for up to 60 days without eligibility.

The member has applied for Medicaid and eligibility is pending with DCF.

The member has gained eligibility and will be enrolled into the previous plan.

About This Quiz

Answer the questions below. This will help you meet the new requirement of 86% passing grade. You may utilize available resources (ie. SMMC Tool Kit, Script, etc. )

2. What first name or nickname would you like us to use?

You may optionally provide this to label your report, leaderboard, or certificate.

2. The recipient calls to enroll into a managed care plan. What are their enrollment options?

Only FFS because they are voluntary.

Cannot enroll into a plan because of an active TPL on file.

They have the option of remaining on FFS or enrolling into a health plan.

Only enroll into a plan and cannot have FFS because of the TPL on file.

3. If a Mandatory recipient calls and states they want straight Medicaid, the agent should:

Immediately advise the caller that is not an option and refer to DCF to get another type of Medicaid.

Advise the caller the request will be submitted and they will have straight Medicaid the 1st of the following month.

Submit the request to the supervisor for approval since people that have special medical needs can have straight Medicaid.

4. For MMA plans, a "temporary loss" is 180 days (6 months) or less?

True

False

5. What does the CARES assessment do?

Identify long-term care needs, recommend the least restrictive, safe, and most appropriate placement and establish the appropriate Level of Care.

Assist with changing direct service providers and ensuring that licensing is up to date.

Screens members and provides information for the Participant Direction Option Program.

Establish Medicaid eligibility and provides counseling for other government funded programs.

6. Continuity of Care would apply to which of the following?

When a recipient changes from one MMA plan to another MMA plan.

When a recipient changes from FFS to a plan.

When a recipient changes from a LTC plan to private insurance.

All of the Above

7. Recipients with HOMESAFENET as an active special condition are eligible to enroll into which specialty plan?

Magellan Complete Care

Sunshine Health Child Welfare Plan

Children's Medical Services Network Specialty Plan

Sunshine Health

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