Dec 26-refresher Activity 2

40 Questions | Total Attempts: 66

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Dec 26-refresher Activity 2

Questions and Answers
  • 1. 
    Why did the member receive the 'LTC Welcome-Non-Fully Eligible' letter?
    • A. 

      The member received the letter because a Medicaid Application was submitted. The letter informs them to wait for approval from DCF before calling to enroll into a LTC plan.

    • B. 

      The letter informs the member they were not approved for LTC.

    • C. 

      The letter includes the member's LTC auto-assignment and start date.

    • D. 

      The member has submitted a Medicaid Application and has established a Level of Care; therefore the member is Application Pending and has the ability to enroll into an LTC plan.

  • 2. 
    What type of request is this?
    • A. 

      A Good Cause plan change request to CMS.

    • B. 

      A 90 day plan change request to CMS.

    • C. 

      A 60 day plan change request to CMS.

  • 3. 
    What type of LTC enrollment request is this?
    • A. 

      Auto-Assignment

    • B. 

      Pending Choice

    • C. 

      Medicaid Pending

    • D. 

      Plan Change

  • 4. 
    This complaint is in what status?
    • A. 

      Resolved

    • B. 

      Open

    • C. 

      AHCA Review

  • 5. 
    When did this member's current Medicaid begin?
    • A. 

      08/01/2008

    • B. 

      06/01/2008

    • C. 

      01/01/2008

    • D. 

      02/01/2008

  • 6. 
    Does this recipient have Medicare coverage?
    • A. 

      Yes

    • B. 

      No

  • 7. 
    What MMA plan is this member currently enrolled in?
    • A. 

      SMMC Long-Term Care (LTCC) effective 09/01/2014

    • B. 

      SMMC MMA Capitated effective 09/01/2014

    • C. 

      Medicaid HMO effective 12/01/2012

    • D. 

      SMMC MMA Capitated effective 11/01/2014

  • 8. 
    When was the active special condition last updated?
    • A. 

      10/01/2006

    • B. 

      06/30/2011

    • C. 

      02/28/2011

    • D. 

      04/30/2014

  • 9. 
    What ACWM does this recipient have?
    • A. 

      MA R

    • B. 

      MI S

    • C. 

      MM P

    • D. 

      MS

  • 10. 
    Caller is locked in and says:  "My doctor said he is no longer taking my plan starting next month. I really like this doctor because he takes his time and explains everything. I want to change the plan so I can keep seeing him."  Which GC would apply?
    • A. 

      GC11

    • B. 

      GC4

    • C. 

      GC9

    • D. 

      GC1

  • 11. 
    A member has called several times and states their doctor will stop taking their current plan starting next month.  You look in HealthTrack and the PCP is still showing with the curent plan, so the GC1(Provider No Longer with Plan) is denied.  You explain this to the caller and they state they have a letter from the doctor's office that states the PCP is no longer taking the plan.  What should you do next?
    • A. 

      Tell the caller to fax the letter so it can be sent to AHCA for verification.

    • B. 

      Tell the caller they have to wait until open enrollment to change.

    • C. 

      Refer the caller to the health plan to request a new doctor.

    • D. 

      Tell the caller to get an out of network authorization.

  • 12. 
    Caller is locked in and says: "The company that delivers my meals told me they will stop taking my plan next month. I really like them because they are always on time and they make good food. Can I change my plan to a plan they will take?" Which Good Cause would you use?
    • A. 

      GC4

    • B. 

      GC1

    • C. 

      GC9

    • D. 

      GC17

  • 13. 
    What is the grievance?
    • A. 

      The grievance is a formal complaint filed by the recipient with the plan concerning issues.

    • B. 

      The grievance is a formal complaint made by the plan against the recipient for complaining.

    • C. 

      The grievance is when the recipient calls AHS and complains about the plan.

    • D. 

      The grievance is a court setting in which the member, health plan, and AHCA meet.

  • 14. 
    If a PACE enrollee no longer needs LTC services...
    • A. 

      Then the member must call PACE.

    • B. 

      Then the member must complete another CARES assessment.

    • C. 

      Then the member must call DOEA.

    • D. 

      Then a disenrollment request can be completed.

  • 15. 
    What are the enrollment options for the recipient below?
    • A. 

      Member can enroll in any plan except PACE.

    • B. 

      Member can only enroll in an HMO.

    • C. 

      Member can enroll in any plan including PACE.

    • D. 

      Member can only enroll in PACE.

  • 16. 
    This member is Excluded under MMA because...
    • A. 

      The member has a PACE exemption.

    • B. 

      The member is receiving medical services through a private insurance.

    • C. 

      PACE provides medical services as well as LTC services.

  • 17. 
    What enrollment options does this member have?
    • A. 

      This member can change to a LTC plan.

    • B. 

      This member can disenroll and use FFS.

    • C. 

      This member can request to disenroll from the LTC program or may remain in their current plan.

    • D. 

      This member must stay enrolled into PACE for a year.

  • 18. 
    If an infant is born on November 6, what date will the newborn's plan be effective?
    • A. 

      January 1

    • B. 

      December 1

    • C. 

      October 1

    • D. 

      November 1

  • 19. 
    If an infant's mom does not want the plan the newborn is being enrolled into and wants to change to another plan, how should you proceed?
    • A. 

      Process the plan change request through the wizard.

    • B. 

      Place the request on a discrepancy log.

    • C. 

      Inform mom the plan cannot be changed.

    • D. 

      Inform mom she has to change her plan first.

  • 20. 
    When is the cut-off date for LTC?
    • A. 

      The cut-off date is the 2nd to the last day of the month.

    • B. 

      The cut-off is the last day of the month

    • C. 

      The cut-off is the Thursday before the 2nd to the last Saturday of the month.

    • D. 

      The cut-off is immediately after the green check mark appears in HealthTrack.

  • 21. 
    If a caller is not eligible for Freedom Health (Specialty Plan) but feels they should be eligible  to enroll, what should you do?
    • A. 

      Advise the caller to contact DCF.

    • B. 

      Advise the caller to contact the AHCA Medicaid Helpline.

    • C. 

      Refer the caller to Freedom Health.

    • D. 

      Place this on the discrepancy log.

  • 22. 
    If the recipient does not want the specialty plan they are being Auto-Assigned to and the recipient has a current, active MMA Auto-Assignment, you should:
    • A. 

      Use the 'convert to voluntary choice' feature to allow the recipient to voluntarily select their current plan.

    • B. 

      Advise the caller, that they need to be in the specialty plan because they qualify for it with the special condition on their file.

    • C. 

      Place the request on the specialty plan discrepancy log.

    • D. 

      Click on the gray arrow for the specialty plan Auto-Assignment and try to cancel the request.

  • 23. 
    The caller states: "The doctor I had under my old plan does not take this new MMA plan, he only takes FFS.  I called the plan and they said I can still see this doctor for my next 2 appointments because they were already scheduled.  Even though the plan is going to cover these appointments, the doctor will not see me because they only take FFS."  How should you proceed?   
    • A. 

      Place on the discrepancy log for an Exemption to be requested from AHCA, so the recipient can see the doctor under FFS.

    • B. 

      Disenroll the recipient so they can use FFS to see their doctor because they have an established active relationship.

    • C. 

      Tell the caller ALL providers must participate in MMA and refer to the Medicaid Area Office.

    • D. 

      Explain continuity of care and file a Complaint against the provider.

  • 24. 
    Caller states:  "I went to the pharmacy to pick up my seizure medication and they told me I had to pay out of pocket because my new plan would not cover it!  It's too expensive, I can't pay for it!  That's why I'm on Medicaid!  I need my medicine!"  How should you proceed?
    • A. 

      Explain continuity of care and tell the caller to call the new plan and provide them with prescription information.

    • B. 

      Tell the caller they will have to pay out of pocket for prescription refills and refer to the Medicaid Area Office.

    • C. 

      File a complaint against the new MMA plan for not covering prescriptions.

    • D. 

      Tell the caller they can use Enhanced Benefits credits to pay for the prescriptions.

  • 25. 
    "I need help with my medications.  My hands shake so much that I can't even take the pills out of the bottle.  I have to give myself my Diabetes shot in my stomach and I can't even fill the syringe with the medicine." Which covered service is the recipient referring to? 
    • A. 

      Medical Equipment and Supplies

    • B. 

      Personal Care

    • C. 

      Respite Care

    • D. 

      Medication Administration

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