Lead Choice Counseling Specialist Interview

1. Pending Choice is when

The managed care plan cannot deny or delay services based on their Medicaid eligibilty status.

The recipient can choose a plan but will not start services until Medicaid has been approved.

Services will start prior to Medicaid being approved.

None of the Above

Pending Choice refers to a situation where the recipient of a managed care plan has the ability to choose a plan, but they will not be able to start receiving services until their Medicaid eligibility has been approved. This means that although they have the option to select a plan, they cannot actually begin using the services until their Medicaid status has been confirmed.

Explanation

Pending Choice refers to a situation where the recipient of a managed care plan has the ability to choose a plan, but they will not be able to start receiving services until their Medicaid eligibility has been approved. This means that although they have the option to select a plan, they cannot actually begin using the services until their Medicaid status has been confirmed.

2. The recipient changed the plan during the Lock-In period using a Good Cause 1. The plan change was approved and the new plan will become effective on 05/01/2015. When will the 90 day change period start?

08/01/2015

05/01/2015

07/01/2015

06/01/2015

The 90 day change period will start on 05/01/2015 because that is when the new plan will become effective.

Explanation

The 90 day change period will start on 05/01/2015 because that is when the new plan will become effective.

3. Caller is locked in and says: "I never picked this plan! You all put me in it! My doctor, that I really like, doesn't take this plan and has never taken it! I've been with the same doctor for years, I don't want to change." Which GC would apply?

GC1

GC8

GC1612

GC9

GC9 would apply in this situation because the caller is expressing dissatisfaction with the plan and specifically mentioning that their preferred doctor does not accept it. GC9 refers to complaints or concerns about the provider network, which includes issues related to the availability and accessibility of preferred doctors or healthcare providers. The caller's statement indicates that they are unhappy with the plan because it does not allow them to continue seeing their preferred doctor.

Explanation

GC9 would apply in this situation because the caller is expressing dissatisfaction with the plan and specifically mentioning that their preferred doctor does not accept it. GC9 refers to complaints or concerns about the provider network, which includes issues related to the availability and accessibility of preferred doctors or healthcare providers. The caller's statement indicates that they are unhappy with the plan because it does not allow them to continue seeing their preferred doctor.

4. Oscar Wilde changed his plan during his Open Enrollment period (5/6/2015 to 07/31/2015). When will his new plan start?

08/01/2015

09/01/2015

10/01/2015

11/01/2015

Oscar Wilde changed his plan during his Open Enrollment period, which was from 5/6/2015 to 07/31/2015. Since his new plan will start after the Open Enrollment period, the earliest possible start date would be the day after the enrollment period ends, which is 08/01/2015.

Explanation

Oscar Wilde changed his plan during his Open Enrollment period, which was from 5/6/2015 to 07/31/2015. Since his new plan will start after the Open Enrollment period, the earliest possible start date would be the day after the enrollment period ends, which is 08/01/2015.

5. Caller is locked in and says: "I have HIV and my doctor told me to change to Clear Health Alliance / Positive HealthCare. I need that to start soon because all of my new specialists take that plan." Which GC would apply?

GC17

GC4

GC9

GC5

The correct answer is GC17. This is because the caller mentions having HIV and needing to switch to Clear Health Alliance / Positive HealthCare because their new specialists accept that plan. GC17 specifically addresses callers with HIV/AIDS who need to switch to a plan that covers their specialists.

Explanation

The correct answer is GC17. This is because the caller mentions having HIV and needing to switch to Clear Health Alliance / Positive HealthCare because their new specialists accept that plan. GC17 specifically addresses callers with HIV/AIDS who need to switch to a plan that covers their specialists.

6. Caller is locked in and says: "Medicaid sent me a letter a while back with my open enrollment dates, but I forgot to call you to change my plan. I think the last day was last Thursday. I just want to change it because my sister said her plan was better than mine." Which GC would apply?

GC1612, because the caller missed open enrollment.

GC1610, it is an error because the member forgot to call us.

None, GC1612 is only used when there is a loss of Medicaid during open enrollment.

GC5, the member has moved out of the county.

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Explanation

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7. 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 current 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?

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

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

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

Tell the caller to get an out of network authorization.

If the member has a letter from the doctor's office stating that the PCP is no longer taking the plan, it is important to verify this information with AHCA (Agency for Health Care Administration) for confirmation. Asking the caller to fax the letter allows for proper documentation and verification of the situation. This will ensure that the member's concerns are addressed and the appropriate actions can be taken to find a new doctor or make necessary changes to the plan if needed.

Explanation

If the member has a letter from the doctor's office stating that the PCP is no longer taking the plan, it is important to verify this information with AHCA (Agency for Health Care Administration) for confirmation. Asking the caller to fax the letter allows for proper documentation and verification of the situation. This will ensure that the member's concerns are addressed and the appropriate actions can be taken to find a new doctor or make necessary changes to the plan if needed.

8. When the member has an issue with thier plan, what should they do first?

Immediately file a grievance.

Call the health plan first, they may be able to assist the member.

File a complaint with the Area Medicaid Office.

Call DCF to file a complaint.

When a member has an issue with their plan, the first step they should take is to call the health plan. By contacting the health plan directly, they may be able to provide assistance and guidance in resolving the issue. This allows the member to address their concerns and potentially find a solution without needing to file a grievance or complaint with other entities such as the Area Medicaid Office or DCF.

Explanation

When a member has an issue with their plan, the first step they should take is to call the health plan. By contacting the health plan directly, they may be able to provide assistance and guidance in resolving the issue. This allows the member to address their concerns and potentially find a solution without needing to file a grievance or complaint with other entities such as the Area Medicaid Office or DCF.

9. One of the GC9 questions in HealthTrack asks: Was the member mandatorily assigned to the current plan? How do you determine this?

Ask the caller if they picked the plan or not.

Just answer "yes" to the question, so that the GC9 can be submitted.

Look in HealthTrack History or FMMIS.

Look at previous call notes, if the previous agent answered "yes", then do the same.

The correct answer is to look in HealthTrack History or FMMIS. This is because these systems contain the necessary information about the member's plan assignment. By reviewing the member's history in HealthTrack or checking the FMMIS system, you can determine whether the member was mandatorily assigned to the current plan or not. This ensures accurate and reliable information for the GC9 submission.

Explanation

The correct answer is to look in HealthTrack History or FMMIS. This is because these systems contain the necessary information about the member's plan assignment. By reviewing the member's history in HealthTrack or checking the FMMIS system, you can determine whether the member was mandatorily assigned to the current plan or not. This ensures accurate and reliable information for the GC9 submission.

10. I am on Medically Needy Medicaid and need to know my share of cost. Who should I call?

SSA

Area Office

Health Plan

DCF

DCF stands for the Department of Children and Families. In this context, the person on Medically Needy Medicaid should call DCF to know their share of cost. DCF is responsible for administering Medicaid programs and can provide information about the individual's specific share of cost based on their eligibility and circumstances.

Explanation

DCF stands for the Department of Children and Families. In this context, the person on Medically Needy Medicaid should call DCF to know their share of cost. DCF is responsible for administering Medicaid programs and can provide information about the individual's specific share of cost based on their eligibility and circumstances.

11. I was told I have a private insurance listed on my case, but I haven't had that for years, who do I call to take that off my case?

Area Office

DCF

The Insurance Company

TPL Corrections

The correct answer is TPL Corrections. TPL stands for Third Party Liability, which refers to any insurance coverage that is not provided by the government. In this case, the individual was informed that they have a private insurance listed on their case, but they haven't had it for years. To remove this incorrect information from their case, they should contact TPL Corrections, who will handle the necessary corrections and updates to their insurance information.

Explanation

The correct answer is TPL Corrections. TPL stands for Third Party Liability, which refers to any insurance coverage that is not provided by the government. In this case, the individual was informed that they have a private insurance listed on their case, but they haven't had it for years. To remove this incorrect information from their case, they should contact TPL Corrections, who will handle the necessary corrections and updates to their insurance information.

12. The recipient calls to make a LTC plan change. What are their options to receive services?

They are not eligible to make a plan change because they are currently in a Nursing Home.

Can change plan to PACE only.

Can change into another available LTC plan.

They must keep the current American Eldercare plan.

The recipient is currently in a Nursing Home, which means they are not eligible to make a plan change. However, they do have the option to change their plan to PACE, which is the only available option for them. They cannot change into another available LTC plan, nor can they keep their current American Eldercare plan.

Explanation

The recipient is currently in a Nursing Home, which means they are not eligible to make a plan change. However, they do have the option to change their plan to PACE, which is the only available option for them. They cannot change into another available LTC plan, nor can they keep their current American Eldercare plan.

13. What options does this recipient have?

Change to another LTC plan.

Inform the recipient they are not eligible to make a plan change because they are eligible for a PACE.

Remain in United or disenroll from United and wait to receive services once Medicaid is approved.

Refer the recipient to DOEA to get an exemption because LTC recipients do not make plan changes without exemptions.

The recipient has the option to either remain in United or disenroll from United and wait to receive services once Medicaid is approved. This suggests that the recipient can choose to continue with their current plan or cancel it and wait for Medicaid to provide the necessary services.

Explanation

The recipient has the option to either remain in United or disenroll from United and wait to receive services once Medicaid is approved. This suggests that the recipient can choose to continue with their current plan or cancel it and wait for Medicaid to provide the necessary services.

14. 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.

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

The correct answer is that the recipient is voluntary because of the TPL on file and they have the options of remaining FFS or enrolling into a Health plan. This means that the recipient has the choice to either continue with Fee-for-Service (FFS) or opt for a managed care Health plan. The presence of a Third Party Liability (TPL) on file does not restrict the recipient from enrolling in a plan, but rather makes their enrollment voluntary.

Explanation

The correct answer is that the recipient is voluntary because of the TPL on file and they have the options of remaining FFS or enrolling into a Health plan. This means that the recipient has the choice to either continue with Fee-for-Service (FFS) or opt for a managed care Health plan. The presence of a Third Party Liability (TPL) on file does not restrict the recipient from enrolling in a plan, but rather makes their enrollment voluntary.

15. Recipients that enroll through Med Pending and start services

Cannot change the plan while in Med Pending.

May be billed for services if Medicaid is denied.

May disenroll.

All of the above.

The statement "Recipients that enroll through Med Pending and start services" implies that the recipients have already enrolled in a plan and have started receiving services. The options state that they cannot change the plan while in Med Pending, may be billed for services if Medicaid is denied, and may disenroll. Therefore, all of the given options are true for recipients who enroll through Med Pending and start services.

Explanation

The statement "Recipients that enroll through Med Pending and start services" implies that the recipients have already enrolled in a plan and have started receiving services. The options state that they cannot change the plan while in Med Pending, may be billed for services if Medicaid is denied, and may disenroll. Therefore, all of the given options are true for recipients who enroll through Med Pending and start services.

16. Why is the recipient listed below Excluded from enrolling into a LTC plan?

Recipient is receiving Medicaid from the Social Security Administration.

Recipient has APD: IC meaning they are currently incarcerated.

Medicaid ended on 5/1/2010.

Recipient is currently living in an Intermediate Care Facility for Persons with Developmental Disabilities.

The recipient is excluded from enrolling into a LTC plan because they are currently living in an Intermediate Care Facility for Persons with Developmental Disabilities.

Explanation

The recipient is excluded from enrolling into a LTC plan because they are currently living in an Intermediate Care Facility for Persons with Developmental Disabilities.

17. Why is the recipient below categorized as Voluntary?

She has (LTCC) indicator next to her level of care.

She has APD: WL meaning she is on the Agency for Persons with Disabilities Waitlist.

She has ( MWA ) ACWM.

She has APD: WL meaning she is on the Weight Loss Waiver Program.

The recipient is categorized as voluntary because she has APD: WL, which stands for Agency for Persons with Disabilities Waitlist. This indicates that she has voluntarily chosen to be on the waitlist for the Agency for Persons with Disabilities, suggesting that she is seeking assistance or support from this agency.

Explanation

The recipient is categorized as voluntary because she has APD: WL, which stands for Agency for Persons with Disabilities Waitlist. This indicates that she has voluntarily chosen to be on the waitlist for the Agency for Persons with Disabilities, suggesting that she is seeking assistance or support from this agency.

18. Which tab below would indicate if the recipient has been pre-approved for CMS?

Special Conditions

Level of Care

Waiver Program

Eligibility

The tab "Special Conditions" would indicate if the recipient has been pre-approved for CMS. This tab is likely to contain information about any specific conditions or requirements that need to be met in order for the recipient to be eligible for CMS. By checking this tab, it can be determined if the recipient has met the necessary criteria for pre-approval.

Explanation

The tab "Special Conditions" would indicate if the recipient has been pre-approved for CMS. This tab is likely to contain information about any specific conditions or requirements that need to be met in order for the recipient to be eligible for CMS. By checking this tab, it can be determined if the recipient has met the necessary criteria for pre-approval.

19. The recipient calls to enroll into a plan. The agent informs the recipient they are not eligible to enroll into a LTC plan because they receive services through the Agency for Persons with Disabilites waiver .

True

False

The recipient is informed by the agent that they are not eligible to enroll in a Long-Term Care (LTC) plan because they receive services through the Agency for Persons with Disabilities waiver. This means that the recipient is already receiving services and support from the waiver program, which likely provides them with the necessary care and assistance. Therefore, enrolling in an LTC plan would not be applicable or necessary for them. Hence, the statement is true.

Explanation

The recipient is informed by the agent that they are not eligible to enroll in a Long-Term Care (LTC) plan because they receive services through the Agency for Persons with Disabilities waiver. This means that the recipient is already receiving services and support from the waiver program, which likely provides them with the necessary care and assistance. Therefore, enrolling in an LTC plan would not be applicable or necessary for them. Hence, the statement is true.

20. If the recipient has an active CMS span on file,...

Then the CMS questions will not have to be asked.

Then they will have to contact CMS directly to enroll.

Then the CMS questions have to be asked.

Then they cannot enroll into CMS.

If the recipient has an active CMS span on file, it means that they are already enrolled in CMS. Therefore, there is no need to ask the CMS questions again since the recipient's information is already on file.

Explanation

If the recipient has an active CMS span on file, it means that they are already enrolled in CMS. Therefore, there is no need to ask the CMS questions again since the recipient's information is already on file.

21. What does the "T" shown for the recipient's LTC coverage mean ?

The recipient's LTC coverage has been terminated and they are no longer receiving services.

The recipient experienced a temporary loss and must pay for services until coverage is reinstated.

The recipient has experienced a temporary loss and will continue services at no charge for 60 days.

The recipient is not eligible to be enrolled into a LTC plan

The "T" shown for the recipient's LTC coverage indicates that the recipient has experienced a temporary loss and will continue to receive services at no charge for a period of 60 days. This means that even though their coverage has been temporarily interrupted, they will still be able to access the necessary services without having to pay for them during this 60-day period.

Explanation

The "T" shown for the recipient's LTC coverage indicates that the recipient has experienced a temporary loss and will continue to receive services at no charge for a period of 60 days. This means that even though their coverage has been temporarily interrupted, they will still be able to access the necessary services without having to pay for them during this 60-day period.

22. If the CMS special condition expires,...

Then the child will have 60 days to continue to recieve services from CMS.

Then the child has been cured of the special condition.

Then the child can enroll into CMS.

Then the child will be disenrolled from CMS.

If the CMS special condition expires, it means that the child's eligibility for CMS services related to that condition is no longer valid. Therefore, the child will be disenrolled from CMS as they no longer meet the criteria for enrollment.

Explanation

If the CMS special condition expires, it means that the child's eligibility for CMS services related to that condition is no longer valid. Therefore, the child will be disenrolled from CMS as they no longer meet the criteria for enrollment.

23. The recipient's mother calls in to enroll her son into a plan. Is the recipient eligible to enroll into a managed care plan?

Yes, this recipient must be enrolled into a managed care plan

No, only recipient 18 and over can enroll into a Managed Medical Assistance plan

No, this recipient has an exemption

No, this recipient's Medicaid coverage ended on 1/1/2006

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Explanation

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24. MMA plans must provide continuity of care for up to _________ days.

90

30

180

60

MMA plans must provide continuity of care for up to 60 days. This means that individuals enrolled in MMA plans can receive uninterrupted medical care for a period of 60 days, ensuring that their healthcare needs are met without any gaps or disruptions in coverage. This provision is important for maintaining the quality and effectiveness of healthcare services provided under MMA plans.

Explanation

MMA plans must provide continuity of care for up to 60 days. This means that individuals enrolled in MMA plans can receive uninterrupted medical care for a period of 60 days, ensuring that their healthcare needs are met without any gaps or disruptions in coverage. This provision is important for maintaining the quality and effectiveness of healthcare services provided under MMA plans.

25. Caller states: "I just started my new plan and just remembered I have an appointment with my old doctor for a procedure. What should I do?" How should you proceed?

Tell the caller the appointment needs to be cancelled and and re-scheduled with the new plan.

Explain Continuity of Care and refer to the new plan for more information.

Tell the caller the previous plan will cover services for up to 60 days.

Tell the caller the appointment will not be covered because the provider is not part of the MMA plan.

The correct answer is to explain Continuity of Care and refer to the new plan for more information. This is the most appropriate response because Continuity of Care ensures that individuals can continue receiving care from their previous healthcare provider for a certain period of time after switching to a new plan. By explaining this concept to the caller and referring them to the new plan for more information, you are addressing their concern and providing them with the necessary guidance to reschedule their appointment.

Explanation

The correct answer is to explain Continuity of Care and refer to the new plan for more information. This is the most appropriate response because Continuity of Care ensures that individuals can continue receiving care from their previous healthcare provider for a certain period of time after switching to a new plan. By explaining this concept to the caller and referring them to the new plan for more information, you are addressing their concern and providing them with the necessary guidance to reschedule their appointment.

26. When did the member's current Medicaid HMO start?

05/01/2014

01/01/2013

03/01/2014

04/01/2013

The member's current Medicaid HMO started on 05/01/2014.

Explanation

The member's current Medicaid HMO started on 05/01/2014.

27. Did the member get auto assigned to the health plan or did they choose it?

Auto Assigned

Voluntary Choice

The member chose the health plan on their own, rather than being automatically assigned to it.

Explanation

The member chose the health plan on their own, rather than being automatically assigned to it.

28. When did the member's most recent Medicaid start?

12/1/2007

3/1/2009

5/1/2010

5/1/2009

The member's most recent Medicaid started on 5/1/2010.

Explanation

The member's most recent Medicaid started on 5/1/2010.

29. What should be selected to view the TPL address and phone number?

A

B

C

D

To view the TPL address and phone number, option B should be selected.

Explanation

To view the TPL address and phone number, option B should be selected.

30. Where should you refer LTC recipients who need additional assistance with changing from a PACE plan?

Local Area Office

Elder Helpline

CARES

DCF

Recipients of LTC (Long-Term Care) who require extra help with transitioning from a PACE (Program of All-Inclusive Care for the Elderly) plan should be referred to the Elder Helpline. The Elder Helpline is a resource that provides assistance and guidance to seniors and their families, offering information on a variety of topics including healthcare options and support services. Therefore, referring LTC recipients to the Elder Helpline would be the appropriate course of action in this scenario.

Explanation

Recipients of LTC (Long-Term Care) who require extra help with transitioning from a PACE (Program of All-Inclusive Care for the Elderly) plan should be referred to the Elder Helpline. The Elder Helpline is a resource that provides assistance and guidance to seniors and their families, offering information on a variety of topics including healthcare options and support services. Therefore, referring LTC recipients to the Elder Helpline would be the appropriate course of action in this scenario.

31. How will PACE enrollees receive their medical services?

Through PACE because PACE covers medical and LTC services.

Through straight medicaid/FFS.

Through a MMA plan.

Through a LTC plan.

PACE enrollees will receive their medical services through PACE because PACE covers both medical and long-term care (LTC) services. PACE, which stands for Program of All-Inclusive Care for the Elderly, is a comprehensive program that provides coordinated and integrated care for individuals who are eligible for both Medicare and Medicaid. PACE organizations arrange and provide all necessary medical, social, and LTC services for their enrollees, allowing them to receive all their needed care through the PACE program.

Explanation

PACE enrollees will receive their medical services through PACE because PACE covers both medical and long-term care (LTC) services. PACE, which stands for Program of All-Inclusive Care for the Elderly, is a comprehensive program that provides coordinated and integrated care for individuals who are eligible for both Medicare and Medicaid. PACE organizations arrange and provide all necessary medical, social, and LTC services for their enrollees, allowing them to receive all their needed care through the PACE program.

32. For LTC plans, enrollees that have a "temporary loss" will

Be responsible to pay for services while experiencing a temporary loss of Medicaid.

Be disenrolled from their Long Term Care plan.

Continue recieving services from the LTC plan for up to 60 days.

None of the above

Enrollees in LTC plans who experience a "temporary loss" will continue receiving services from the LTC plan for up to 60 days. This means that even if they temporarily lose their Medicaid coverage, they will still be able to receive the necessary services from the LTC plan during that period. This ensures that individuals do not face a disruption in their care while they work to reinstate their Medicaid coverage.

Explanation

Enrollees in LTC plans who experience a "temporary loss" will continue receiving services from the LTC plan for up to 60 days. This means that even if they temporarily lose their Medicaid coverage, they will still be able to receive the necessary services from the LTC plan during that period. This ensures that individuals do not face a disruption in their care while they work to reinstate their Medicaid coverage.

33. When will the 90 day trial period start for Med Pending enrollments?

90 days will start as soon as the plan starts.

90 days will start on the first month eligibility has been received.

LTC recipients do not get 90 days to try out the plan.

90 days will start after open enrolllment.

The correct answer is "90 days will start on the first month eligibility has been received." This means that once a person becomes eligible for the Med Pending enrollment, the 90-day trial period will begin in the first month of their eligibility.

Explanation

The correct answer is "90 days will start on the first month eligibility has been received." This means that once a person becomes eligible for the Med Pending enrollment, the 90-day trial period will begin in the first month of their eligibility.

34. What should you do if the HIV/AIDS special condition is not listed in the system?

Tell the caller their doctor must update their medical record and report it to AHCA.

Tell the caller to fax us documentation of the special condition, so the case can be updated.

Tell the caller they must report their special condition to the Center's for Disease Control and the Department of Health.

If the HIV/AIDS special condition is not listed in the system, the appropriate action would be to tell the caller to fax documentation of the special condition. This is necessary in order for the case to be updated and for the system to reflect the caller's special condition accurately.

Explanation

If the HIV/AIDS special condition is not listed in the system, the appropriate action would be to tell the caller to fax documentation of the special condition. This is necessary in order for the case to be updated and for the system to reflect the caller's special condition accurately.

35. What are the enrollment options for the recipient below?

Member can enroll in any plan except PACE.

Member can only enroll in an HMO.

Member can enroll in any plan including PACE.

Member can only enroll in PACE.

The correct answer is "Member can only enroll in PACE." This means that the recipient has limited options for enrollment and can only choose the PACE plan. They are not eligible to enroll in any other plan except for PACE.

Explanation

The correct answer is "Member can only enroll in PACE." This means that the recipient has limited options for enrollment and can only choose the PACE plan. They are not eligible to enroll in any other plan except for PACE.

36. To complete a plan change from PACE into a LTC plan, the recipient must

Complete the plan change online.

Call SSA.

Call the Elder Helpline.

Call the SMMC line to request a plan change.

To complete a plan change from PACE into a LTC plan, the recipient must call the Elder Helpline. This suggests that the Elder Helpline is the appropriate channel for the recipient to request a plan change. The other options, such as completing the plan change online, calling SSA, or calling the SMMC line, are not mentioned as necessary steps for completing the plan change. Therefore, calling the Elder Helpline seems to be the correct course of action in this scenario.

Explanation

To complete a plan change from PACE into a LTC plan, the recipient must call the Elder Helpline. This suggests that the Elder Helpline is the appropriate channel for the recipient to request a plan change. The other options, such as completing the plan change online, calling SSA, or calling the SMMC line, are not mentioned as necessary steps for completing the plan change. Therefore, calling the Elder Helpline seems to be the correct course of action in this scenario.

37. This member is Excluded under MMA because...

The member has a PACE exemption.

The member is receiving medical services through a private insurance.

PACE provides medical services as well as LTC services.

PACE (Programs of All-Inclusive Care for the Elderly) is a healthcare program that provides comprehensive medical and long-term care services to eligible individuals. This includes both medical services, such as doctor visits and hospital care, as well as long-term care services, such as nursing home care and assistance with daily activities. Therefore, if a member is excluded under MMA (Medicare Modernization Act), it means that they are not eligible for PACE services, which include both medical and long-term care services.

Explanation

PACE (Programs of All-Inclusive Care for the Elderly) is a healthcare program that provides comprehensive medical and long-term care services to eligible individuals. This includes both medical services, such as doctor visits and hospital care, as well as long-term care services, such as nursing home care and assistance with daily activities. Therefore, if a member is excluded under MMA (Medicare Modernization Act), it means that they are not eligible for PACE services, which include both medical and long-term care services.