Smmc: Written Assessment

60 Questions | Total Attempts: 840

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Smmc:  Written Assessment

Questions and Answers
  • 1. 
    For details about benefits or prior authorizations that are not listed on the plan brochure, the recipient must call:
    • A. 

      AHCA

    • B. 

      The plan

    • C. 

      DCF

    • D. 

      SSA

  • 2. 
    Who can disenroll to terminate LTC services?
    • A. 

      Recipients that need FFS because their provider doesn't accept a LTC plan.

    • B. 

      Recipients that are currently residing in a nursing home.

    • C. 

      Only recipients that are Voluntary.

    • D. 

      Recipients that no longer need LTC services.

  • 3. 
    MMA plans must provide continuity of care for up to _________ days.
    • A. 

      90

    • B. 

      30

    • C. 

      180

    • D. 

      60

  • 4. 
    Recipients with HOMESAFENET as an active special condition are eligible to enroll into which specialty plan?
    • A. 

      Magellan Complete Care

    • B. 

      Sunshine Health Child Welfare Plan

    • C. 

      Children's Medical Services Network Specialty Plan

    • D. 

      Sunshine Health

  • 5. 
    Sirena Robinson calls to verify the current plan for herself and her newborn child. When the counselor tells her she is not the authorized person on the case she states she has been emancipated from her mother.  Which statement is correct?
    • A. 

      The counselor can continue with the call because Sirena stated that she is emancipated.

    • B. 

      The call cannot continue because Sirena is under 18 years of age and counselors are never allowed to speak to members who are under age 18.

    • C. 

      The counselor should notify Sirena that legal documentation of her emancipation must be faxed in before she can speak for herself; she can continue the call on the newborn's behalf.

    • D. 

      Sirena must contact DCF to have a note placed on her case stating that she is emancipated.

  • 6. 
    When a name is listed in the address field with C/O (in care of)...
    • A. 

      The caller must still follow the normal verification procedures.

    • B. 

      They are automatically authorized.

    • C. 

      The caller must fax in legal documentation.

  • 7. 
    Rita Bailey calls in and states she wants to complain against her plan because she is being required to pay for services the plan is supposed to cover. What Issue Category should you select?
    • A. 

      AHCA

    • B. 

      Billing and Payment

    • C. 

      Marketing

    • D. 

      Network Access

  • 8. 
    Anita Stephens calls in to complain against an AHS Choice Counseling Specialist because the agent  was "rude" and "disrespectful" when she requested a plan change yesterday. How should you proceed?
    • A. 

      Escalate the call to a Supervisor for further assistance with the customer service issue.

    • B. 

      Submit a call back request to have a Supervisor assist Anita.

    • C. 

      Refer to AHCA Medicaid Helpline because they are required to process complaints against AHS.

    • D. 

      Process the complaint request through HeathTrack and provide Anita with the complaint number.

  • 9. 
    If a Mandatory recipient calls and states they want straight Medicaid, the agent should:
    • A. 

      Immediately advise the caller that is not an option and end the call.

    • B. 

      Advise the caller they are required to be in a plan to continue receiving services and ask what is their reason for wanting FFS/Straight Medicaid.

    • C. 

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

    • D. 

      Submit the request to the supervisor for approval.

  • 10. 
    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? 
    • A. 

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

    • B. 

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

    • C. 

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

    • D. 

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

  • 11. 
    The QMB Program
    • A. 

      Allows qualified individuals to have Medicaid pay for their Medicare premiums, deductibles, and coinsurance.

    • B. 

      Allows qualified individuals to have Medicaid pay Medicare for Medicare Part B premiums.

    • C. 

      Allows qualified individuals the option to enroll into Medicaid Managed Care Plans outside of their region.

    • D. 

      Allows qualified individuals the option to hire a family member to help provide services in the home.

  • 12. 
    The SLMB Program
    • A. 

      Allows qualified individuals to have Medicaid pay Medicare for Medicare Part B premiums.

    • B. 

      Allows qualified individuals the option to enroll into Medicaid Managed Care Plans outside of their region.

    • C. 

      Allows qualified individuals to have Medicaid pay for their Medicare premiums, deductibles, and coinsurance.

    • D. 

      Allows qualified individuals the option to hire a family member to help provide services in the home.

  • 13. 
    To complete a plan change from PACE into a LTC plan, the recipient must
    • A. 

      Complete the plan change online.

    • B. 

      Call SSA.

    • C. 

      Call the Elder Helpline.

    • D. 

      Call the SMMC line to request a plan change.

  • 14. 
    "My neighbor Sue helps me during the day.  She cooks for me and helps me around the house.  I really appreciate her help, but she will be going out of town for a week.  I won't have anyone to help me until she gets back." Which covered service is the recipient referring to?   
    • A. 

      Assistive Care Services

    • B. 

      Attendant Care

    • C. 

      Homemaker Services

    • D. 

      Personal Care

  • 15. 
    What does the "T" shown for the recipient's LTC coverage mean ?
    • A. 

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

    • B. 

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

    • C. 

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

    • D. 

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

  • 16. 
    A worker for the Department of Children and Families or Community Based Care calls. How do you proceed?
    • A. 

      Inform the caller that you are not allowed to speak with any agencies and instruct them to have the member call back.

    • B. 

      Document the callers Name, DOB, last 5 of SSN, and Certification or License Number and continue with the call.

    • C. 

      Document the caller's Name, Agency & Title, Work Phone Number, Statement of Authority and continue with the call.

  • 17. 
    If the CMS special condition expires,...
    • A. 

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

    • B. 

      Then the child has been cured of the special condition.

    • C. 

      Then the child can enroll into CMS.

    • D. 

      Then the child will be disenrolled from CMS.

  • 18. 
    If a newly eligible child has an active CMS and HOMESAFENET span, which specialty plan will the member be auto-assigned to based on the specialty plan hierarchy?
    • A. 

      Sunshine Health Child Welfare

    • B. 

      Magellan Complete Care

    • C. 

      Children's Medical Services

    • D. 

      Positive Healthcare/Clear Health Alliance

  • 19. 
    My name is Dr. Smith and I need to verify the Medicaid eligibility for Jon Doe.  Where do I call?
    • A. 

      SSA

    • B. 

      AHCA Medicaid Helpline

    • C. 

      Provider Needs Eligibility Information

    • D. 

      DCF

  • 20. 
    Why is the member listed below Excluded from enrolling into a LTC plan?
    • A. 

      He is receiving Medicaid from the Social Security Administration.

    • B. 

      He has ADP: IC meaning he is currently incarcerated.

    • C. 

      His Medicaid ended on 5/1/2010.

    • D. 

      He Is currently living in an Intermediate Care Facility for Persons with Developmental Disabilities.

  • 21. 
    Why is the member below categorized as Voluntary under LTC?
    • A. 

      She has (LTCC) indicator next to her Level of Care.

    • B. 

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

    • C. 

      She has ( MWA ) ACWM.

    • D. 

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

  • 22. 
    For the LTC program, enrollees that are in a "temporary loss" period will
    • A. 

      Have to start the enrollment process to be eligible for the LTC program all over.

    • B. 

      Be responsible for paying the plan for services received during the temporary loss.

    • C. 

      Continue receiving services from the LTC plan for up to 60 days and cannot change plans.

    • D. 

      Have the option to change to a different LTC plan if they choose to.

  • 23. 
    With Medicaid Pending
    • A. 

      If the recipient is deemed not eligible for Medicaid, then they are not responsible for any services rendered and the managed care plan may terminate services and seek reimbursement.

    • B. 

      The recipient cannnot change to a different managed care plan but can disenroll to discontinue services.

    • C. 

      The recipient will have 60 days to obtain Medicaid eligibility.

    • D. 

      Recipients that are in a nursing facility are also eligible to enroll under Medicaid Pending.

  • 24. 
    For LTC, Pending Choice is when 
    • A. 

      The recipient is not eligible and will receive services regardless of their Medicaid eligibility status.

    • B. 

      The recipient can choose to enroll and not start services until Medicaid has been approved.

    • C. 

      The recipient can receive services from the plan while their Medicaid eligibility is being determined.

    • D. 

      The recipient is Medicaid eligible and is waiting to be approved for entry into the LTC program.

  • 25. 
    What does the CARES assessment do?
    • A. 

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

    • B. 

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

    • C. 

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

    • D. 

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

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