11.19 Abbreviated Smmc & Dental Final
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- 1.
The caller is enrolled in a MMA plan and wants to know if acupuncture is covered by the plan. How do you proceed?
- A.
Refer to SSA
- B.
Refer to DCF
- C.
Refer to the MMA plan
- D.
Refer to AHCA
Correct Answer
C. Refer to the MMA planExplanation
To proceed with the caller's query about acupuncture coverage, it is best to refer to the MMA plan. The MMA plan, which stands for Medicare Advantage plan, is a type of health insurance plan offered by private companies approved by Medicare. It provides coverage beyond what Original Medicare offers, including additional benefits such as acupuncture. Therefore, referring to the MMA plan will provide the caller with accurate information regarding their coverage for acupuncture.Rate this question:
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- 2.
The caller needs a list of providers that accept FFS/straight Medicaid. How do you proceed?
- A.
Refer to DOEA
- B.
Refer to AHCA
- C.
Refer to SSA
- D.
Refer to the MMA plan
Correct Answer
B. Refer to AHCAExplanation
To proceed with providing a list of providers that accept FFS/straight Medicaid, it is best to refer to AHCA (Agency for Health Care Administration). AHCA is responsible for managing Florida's Medicaid program and can provide the most accurate and up-to-date information on providers who accept this type of Medicaid.Rate this question:
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- 3.
Recipients that are REQUIRED to enroll in a managed care plan are
- A.
Voluntary
- B.
Not Eligible
- C.
Excluded
- D.
Mandatory
Correct Answer
D. MandatoryExplanation
Recipients that are required to enroll in a managed care plan are mandatory. This means that these recipients do not have the option to choose whether or not to enroll in the plan. They are obligated to do so. This could be due to various reasons such as government regulations or specific eligibility criteria that make enrollment mandatory for certain individuals.Rate this question:
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- 4.
Which dental benefit below is NOT available for Medicaid recipients over 21?
- A.
Dental Exams
- B.
Teeth Cleanings
- C.
Sedations
- D.
Extractions
Correct Answer
B. Teeth CleaningsExplanation
Medicaid recipients over 21 are eligible for dental exams, sedations, and extractions. However, teeth cleanings are not available as a dental benefit for Medicaid recipients over 21.Rate this question:
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- 5.
Which are the special conditions required to enroll in a specialty plan?
- A.
Children with chronic conditions, children in child welfare, individuals with HIV/AIDS, and individuals with serious mental illness
- B.
Children with chronic conditions, adults with seizures, adults with heart problems, and individuals with serious mental illness
- C.
Children that were premature, adults with depression, adults with diabetes, and individuals with brain trauma
- D.
Children with chronic conditions, adults with asthma, adults with HIV/AIDS, and individuals with serious mental illness
Correct Answer
A. Children with chronic conditions, children in child welfare, individuals with HIV/AIDS, and individuals with serious mental illnessExplanation
The special conditions required to enroll in a specialty plan include children with chronic conditions, children in child welfare, individuals with HIV/AIDS, and individuals with serious mental illness. These individuals have specific healthcare needs that may require specialized care and treatment, which is why they are eligible for enrollment in a specialty plan. This plan would provide them with the necessary services and support to address their unique health conditions and ensure they receive appropriate care.Rate this question:
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- 6.
If the caller does not have a dentist, you should:
- A.
Offer to search for a dentist in the area, ask for preferences such as male or female, a language preference, etc.
- B.
Tell the caller to research the dentists in the area and call us back
- C.
Tell the caller the plan will send a list of dentists when the plan becomes effective
- D.
Provide the caller the plan website so they can get a full list of dentists
Correct Answer
A. Offer to search for a dentist in the area, ask for preferences such as male or female, a language preference, etc.Explanation
The correct answer is to offer to search for a dentist in the area and ask for preferences such as male or female, a language preference, etc. This option shows proactive customer service by providing assistance and personalized recommendations based on the caller's preferences. It demonstrates a willingness to help the caller find a suitable dentist and addresses their specific needs and concerns.Rate this question:
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- 7.
An enrollee asks, “When will the dental plan send my card?” What should you inform the enrollee?
- A.
Inform the enrollee that they will receive the dental card prior to when their enrollment begins
- B.
Advise the enrollee that the dental card should come after the effective date
- C.
Inform the enrollee that they should receive the dental card within 5-7 business days
- D.
Refer the enrollee to the AHCA Medicaid Helpline to ask when the dental card will be sent
Correct Answer
B. Advise the enrollee that the dental card should come after the effective dateExplanation
The correct answer is to advise the enrollee that the dental card should come after the effective date. This means that the dental plan will send the card once the enrollee's enrollment becomes active.Rate this question:
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- 8.
When a recipient has an "A" or "N" in HT for MMA and Dental, you should...
- A.
Refer the caller to DCF/SSA because they are not eligible yet
- B.
Do not ask questions and automatically transfer to extension 2042
- C.
Transfer to Express Enrollment
- D.
Advise the recipient to allow 24-48 business hours for their eligibility to update and call back
Correct Answer
C. Transfer to Express EnrollmentExplanation
When a recipient has an "A" or "N" in HT for MMA and Dental, the appropriate action is to transfer them to Express Enrollment. This is because Express Enrollment is the department responsible for handling eligibility updates and enrollment in healthcare programs. By transferring the caller to Express Enrollment, they will be able to assist the recipient in updating their eligibility status and provide any necessary information or assistance regarding their enrollment in MMA and Dental programs.Rate this question:
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- 9.
Which specialty plan will this enrollee be auto-assigned to first?
- A.
Staywell
- B.
Children’s Medical Services
- C.
Sunshine Health
- D.
Clear Health Alliance
Correct Answer
D. Clear Health AllianceExplanation
This enrollee will be auto-assigned to Clear Health Alliance first because it is the last option listed.Rate this question:
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- 10.
What plan types will this recipient be able to enroll into?
- A.
MMA-only plans, the LTC+ Plan, Comprehensive Plans and Dental Plans
- B.
Only the LTC+ Plan and Dental Plans
- C.
The LTC+ Plan, Comprehensive Plans and Dental Plans
- D.
All SMMC and Dental plans will be available to the recipient
Correct Answer
C. The LTC+ Plan, Comprehensive Plans and Dental PlansExplanation
The recipient will be able to enroll in the LTC+ Plan, Comprehensive Plans, and Dental Plans.Rate this question:
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- 11.
If the dentist does not populate in HealthTrack, how should the agent proceed?
- A.
Inform the caller that their dentist does not participate with the SMMC plans and a new dentist will be auto-assigned by the plan
- B.
Advise the caller to contact the plan after it becomes effective to add the dentist to the enrollment
- C.
Tell the caller that they will need to choose a new dentist and ask for their preferences to search for a different dentist in HealthTrack
- D.
Refer the caller to the AHCA Medicaid Helpline to get a list of dental providers
Correct Answer
B. Advise the caller to contact the plan after it becomes effective to add the dentist to the enrollmentExplanation
If the dentist does not populate in HealthTrack, the agent should advise the caller to contact the plan after it becomes effective to add the dentist to the enrollment. This means that the caller can still have their preferred dentist added to their plan, but they will need to contact the plan directly to make the necessary arrangements.Rate this question:
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- 12.
Which are examples of expanded benefits?
- A.
Prescriptions, Check Ups, Laboratory, X Rays, Plastic Surgery
- B.
Over the Counter Benefit, Vision Services, Waived Copayments
- C.
Surgery, Birthing Center Services, Hospice Services
- D.
Emergency Services, Transportation, Podiatric Services, Aromatherapy
Correct Answer
B. Over the Counter Benefit, Vision Services, Waived CopaymentsExplanation
The examples of expanded benefits listed in the answer are Over the Counter Benefit, Vision Services, and Waived Copayments. These benefits go beyond the basic coverage and provide additional services or cost savings for the insured individuals. Over the Counter Benefit allows the insured to purchase certain medications or health-related products without a prescription. Vision Services cover eye exams, glasses, and contact lenses. Waived Copayments means that the insured does not have to pay the usual copayment amount for certain services. These expanded benefits enhance the overall coverage and provide more value to the insured individuals.Rate this question:
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- 13.
When a recipient has an "A" for LTC, you should...
- A.
Refer the caller to DCF/SSA because they are not eligible yet
- B.
Process the enrollment as a pending choice for the LTC plan and inform the caller that the plan will become effective when the eligibility is approved
- C.
Transfer to Express Enrollment
- D.
Advise the recipient to allow 24-48 business hours for their eligibility to update and call back
Correct Answer
B. Process the enrollment as a pending choice for the LTC plan and inform the caller that the plan will become effective when the eligibility is approvedExplanation
When a recipient has an "A" for LTC, it means that their eligibility for long-term care has not been approved yet. Therefore, the correct action to take is to process the enrollment as a pending choice for the LTC plan and inform the caller that the plan will become effective once their eligibility is approved. This ensures that the recipient's application is considered and their enrollment is pending approval.Rate this question:
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- 14.
Which of the following listed below is not a Prohibited Activity?
- A.
Agent states: "Yes, this LTC+ plan will best meet all of your needs."
- B.
Agent states: "My grandmother has that plan, you'd probably like it too."
- C.
Agent states: " You'd get more services and better doctors with this plan."
- D.
Agent states: "All SMMC and Dental plans offer dental services. If the information you need is not available on the brochure, contact the plan for more information."
Correct Answer
D. Agent states: "All SMMC and Dental plans offer dental services. If the information you need is not available on the brochure, contact the plan for more information."Explanation
The given answer is not a prohibited activity because it provides accurate information about the availability of dental services in SMMC and Dental plans and suggests contacting the plan for more information if needed. Prohibited activities typically involve making false or misleading statements, providing incorrect information, or engaging in unethical practices to deceive or manipulate individuals. The given statement does not fall into any of these categories.Rate this question:
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- 15.
For MMA, Enrollees whose Medicaid eligibility ends for less than 6 months (180 days) are in a ________________________ period. If Medicaid eligibility is regained, they will be reinstated back into the plan they had previously (if available).
- A.
No change
- B.
Open enrollment
- C.
Reinstatement
- D.
Lock-In
Correct Answer
C. ReinstatementExplanation
Enrollees whose Medicaid eligibility ends for less than 6 months are in a reinstatement period. This means that if their Medicaid eligibility is regained, they will be reinstated back into the plan they had previously, if it is still available. This period allows individuals to continue their coverage without having to go through the open enrollment process or being locked into a specific plan.Rate this question:
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- 16.
Can recipients who are eligible for both MMA and LTC enroll into a Specialty plan if they have an active Special Condition on file?
- A.
No, Specialty Plans cannot provide LTC Services and will not be an option for LTC eligible recipients.
- B.
Yes, as long as the Special Condition is active, Specialty Plans will be available to the recipient.
- C.
Yes, Specialty Plans are available in all regions for all the Special Conditions.
- D.
No, Specialty Plans are only available for recipients under the age of 21.
Correct Answer
A. No, Specialty Plans cannot provide LTC Services and will not be an option for LTC eligible recipients.Explanation
Specialty Plans are not available for recipients who are eligible for Long-Term Care (LTC) services. This means that recipients who have an active Special Condition on file and are eligible for both Medicare and Medicaid cannot enroll in a Specialty plan. Specialty Plans do not offer LTC services, so they are not an option for LTC eligible recipients.Rate this question:
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- 17.
If a caller requests a PCP during the enrollment and after the first attempt you cannot find the PCP in the provider search you should...
- A.
Ask the caller for more information and keep trying to find a PCP
- B.
Advise the caller that the PCP wasn't found in the provider search because the doctor is not accepting the plan
- C.
Advise the caller that the PCP was not found in our system. That doesn't mean that the doctor is not accepting the plan and she/he can contact the plan once is effective to add the PCP
- D.
Inform the caller That you cannot complete the enrollment without the PCP
Correct Answer
C. Advise the caller that the PCP was not found in our system. That doesn't mean that the doctor is not accepting the plan and she/he can contact the plan once is effective to add the PCPExplanation
The correct answer is to advise the caller that the PCP was not found in the system. This is because the provider search may not always have the most up-to-date information, and just because the PCP was not found does not mean that the doctor is not accepting the plan. The caller can contact the plan once it becomes effective to add the PCP.Rate this question:
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- 18.
This enrollee wants to know what plan they currently have. What can you inform them?
- A.
Advise the enrollee that they are currently enrolled with Simply Healthcare for MMA and LTC services, Also enrolled with LIBERTY for the dental plan, and both plans were effective 12/01/2018
- B.
Inform the enrollee they are not currently enrolled in a plan for MMA and LTC and need to choose a plan for dental since they don't have one
- C.
Tell the enrollee that they are being disenrolled from Simply Healthcare, but you can assist them to enroll into one of the plans currently available in their area. Advise the enrollee that they will need to choose a dental plan, or they will be auto-assigned.
- D.
Notify the enrollee that because there are new plans available through the new Statewide Medicaid Managed Care Program, they will be auto-assigned to both a new Health and Dental Plan.
Correct Answer
A. Advise the enrollee that they are currently enrolled with Simply Healthcare for MMA and LTC services, Also enrolled with LIBERTY for the dental plan, and both plans were effective 12/01/2018Explanation
The explanation for the given correct answer is that the enrollee is currently enrolled with Simply Healthcare for MMA and LTC services, as well as with LIBERTY for the dental plan. Both of these plans became effective on 12/01/2018. This information provides the enrollee with an understanding of their current plan coverage and effective dates.Rate this question:
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- 19.
This enrollee heard about the changes happening in their area and want to know what is happening in their case. Which option provides the best overview of the case?
- A.
Inform the enrollee that due to the changes in the Statewide Medicaid Managed Care Program, they are being disenrolled from United Healthcare and enrolled back into the same plan effective 2/1/2019 since United Healthcare is available in the area under the New Program. MCNA Dental will be effective 2/1/2019 as well.
- B.
Advise the enrollee that due to the changes in the Statewide Medicaid Managed Care Program, they are being disenrolled from United Healthcare and they will have to wait until 2/1/2019 to make a plan change.
- C.
Tell the enrollee that due to the changes in the Statewide Medicaid Managed Care program, they are being disenrolled from United Healthcare and they should contact AHCA if they want to keep the plan. Advise they have an auto-assignment into MCNA and can choose their dental plan.
- D.
Inform the enrollee that changes are being made to the Statewide Medicaid Managed Care program, and to call back after 2/1/2019 to get more information about what options are available.
Correct Answer
A. Inform the enrollee that due to the changes in the Statewide Medicaid Managed Care Program, they are being disenrolled from United Healthcare and enrolled back into the same plan effective 2/1/2019 since United Healthcare is available in the area under the New Program. MCNA Dental will be effective 2/1/2019 as well.Explanation
The option provides the best overview of the case because it informs the enrollee about the changes in the Statewide Medicaid Managed Care Program, specifically stating that they are being disenrolled from United Healthcare and enrolled back into the same plan effective 2/1/2019. It also mentions that United Healthcare is available in the area under the New Program and that MCNA Dental will be effective from the same date. This gives the enrollee a clear understanding of the changes happening and the timeline for the transition.Rate this question:
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- 20.
Who can enroll in a Comprehensive Plan?
- A.
MMA recipients, MMA recipients eligible for a specialty plan, and LTC recipients
- B.
LTC and Medicare recipients only
- C.
Everyone except recipients that qualify for a specialty plan
- D.
MMA recipients eligible for a specialty plan and LTC recipients
Correct Answer
A. MMA recipients, MMA recipients eligible for a specialty plan, and LTC recipientsExplanation
The Comprehensive Plan is available for MMA recipients, MMA recipients eligible for a specialty plan, and LTC recipients. This means that individuals who receive MMA benefits, those who are eligible for a specialty plan under MMA, and long-term care recipients are all eligible to enroll in the Comprehensive Plan.Rate this question:
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- 21.
The caller needs to know what plan their child has, and when reviewing the case, you see a "K" for the eligibility category and the child is enrolled in Sunshine Health. How do you proceed?
- A.
Refer to Sunshine Health
- B.
Refer to DCF
- C.
Refer to the MediKids Helpline
- D.
Refer to the AHCA Medicaid Helpline
Correct Answer
C. Refer to the MediKids HelplineExplanation
The caller needs to know what plan their child has, and since the child is enrolled in Sunshine Health, it would be appropriate to refer them to the MediKids Helpline. The MediKids Helpline is likely to have information about the specific plans and eligibility categories under Sunshine Health, which can help the caller determine the child's plan.Rate this question:
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- 22.
Sonia Allen is new to Medicaid. She just enrolled into a plan for the first time and is worried that she may not like it. What can you tell her?
- A.
"Since this is free medical care, once you enroll you cannot change it."
- B.
"Don't worry, you have 60 days for open enrollment to change the plan for any reason, call us back if you want to change the plan."
- C.
"Once you enroll, you will be in a no change period, and you will not be able to change the plan."
- D.
"Don't worry, you have 120 days to change the plan for any reason. Call us back if you want to change the plan."
Correct Answer
D. "Don't worry, you have 120 days to change the plan for any reason. Call us back if you want to change the plan."Explanation
The correct answer is "Don't worry, you have 120 days to change the plan for any reason. Call us back if you want to change the plan." This answer reassures Sonia that she has a designated period of time, 120 days, to change her plan if she is not satisfied with it. It also encourages her to reach out and contact the provider if she decides to make a change. This option provides Sonia with flexibility and options, alleviating her concerns about being stuck with a plan she may not like.Rate this question:
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- 23.
A mother from Region 9 wants to know when circumcision is no longer available through Humana for her baby. What can you advise the caller?
- A.
Since circumcision is available on the Expanded Benefits grid, there is no timeframe and she can have the circumcision performed at any time.
- B.
The information for circumcision shows it is for newborns only, so if she does not have the procedure immediately after the baby is born, it will not be covered.
- C.
Circumcisions are generally performed within the first 48 hours and up to three weeks after birth, so if it is past that timeframe, the service may not be covered.
- D.
Advise the caller to contact the plan to get more information on the timeframe for when circumcisions are covered.
Correct Answer
D. Advise the caller to contact the plan to get more information on the timeframe for when circumcisions are covered.Explanation
The correct answer advises the caller to contact the plan to get more information on the timeframe for when circumcisions are covered. This is because the previous options provide conflicting information. The first option suggests that there is no specific timeframe and circumcision can be performed at any time. The second option states that circumcision is only covered for newborns and must be done immediately after birth. The third option mentions a timeframe of up to three weeks after birth. Therefore, to provide accurate information, it is best for the caller to directly contact the plan for clarification.Rate this question:
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- 24.
Which of the following plans is an option for enrollment?
- A.
United Health Care of Florida
- B.
Children's Medical Services
- C.
Staywell
- D.
Humana Medical Plan
Correct Answer
D. Humana Medical Plan -
- 25.
A caller asks if their local Hospital, Florida Medical Center, accepts their plan Simply Healthcare. What can you inform the caller?
- A.
Inform the caller Florida Medical Center will take all of the Medicaid plans.
- B.
Inform the caller that Florida Medical Center accepts Simply HealthCare but only for recipients in Broward County.
- C.
Inform the caller that Florida Medical Center accepts Simply HealthCare.
- D.
Inform the caller Florida Medical Center does not accept Simply HealthCare.
Correct Answer
C. Inform the caller that Florida Medical Center accepts Simply HealthCare.Explanation
The correct answer is that the caller should be informed that Florida Medical Center accepts Simply HealthCare.Rate this question:
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.PNG "A mother from Region 9 wants to know when circumcision is no longer available through Humana for her baby. What can you advise the caller?")
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