Smmc: Program Information Quiz

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  • 1/40 Questions

    The Special Needs Unit consists of

    • CMS case workers.
    • Trained nurses skilled to assist with children with special needs.
    • Trained nurses staffed to help AHS employees with their complex medical needs.
    • Trained nurses staffed to assist recipients with complex medical needs.
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  • 2. 

    Which applicant below will be directed to use the Express Enrollment website?

    • KidCare Applicants

    • DCF Applicants

    • SSA Applicants

    • WIC Applicants

    Correct Answer
    A. DCF Applicants
  • 3. 

    Express Enrollments will be effective

    • When Medicaid is approved. The effective date can be any day of the month.

    • When Medicaid is approved. The effective date is always on the first of the month.

    • As soon as the applicant applies for Medicaid, even if the status is "Processing".

    • The following month. The recipient will have FFS for the first month.

    Correct Answer
    A. When Medicaid is approved. The effective date can be any day of the month.
  • 4. 

    Recipients will have  __________ days to change the plan without a Good Cause Reason.

    • 180

    • 90

    • 120

    • 30

    Correct Answer
    A. 120
  • 5. 

    For entry into the LTC program you must:

    • Be at least 18 years old, File for financial eligibility and Meet the required Level of Care.

    • Be 65 or older, need someone to care for you and already be approved for Medicare.

    • Have filed for a disability check, food and medical assistance through SSA.

    • Need someone to take care of you while your family goes to work.

    Correct Answer
    A. Be at least 18 years old, File for financial eligibility and Meet the required Level of Care.
  • 6. 

    What are the two components that make up the Statewide Medicaid Managed Care Program?

    • AHCA and The Florida Legislature

    • DCF & SSA

    • LTC & MMA

    • LTC & CARES

    Correct Answer
    A. LTC & MMA
  • 7. 

    Which of the following services is not provided by the Long Term Care program?

    • Respite Care

    • Adult Day Healthcare

    • Home Delivered Meals

    • Prescription Medication

    • Assisted Living

    Correct Answer
    A. Prescription Medication
  • 8. 

    Which agencies determine Medicaid eligibility?

    • DCF and SSA

    • Elder Affairs and CARES

    • HMO's and PSN's

    • AHCA and DOEA

    Correct Answer
    A. DCF and SSA
  • 9. 

    Fee-For-Service is also known as

    • Pre-Paid Medicaid

    • Straight Medicaid

    • Medically Needy

    • Basic Services

    Correct Answer
    A. Straight Medicaid
  • 10. 

    Which are examples of extra (expanded) benefits?

    • Prescriptions, Check Ups, Laboratory, X Rays

    • Over the Counter Items, Circumcision, Adult Dental, Pet Therapy

    • Surgery, Birthing Center Services, Hospice Services

    • Emergency Services, Transportation, Podiatric Services

    Correct Answer
    A. Over the Counter Items, Circumcision, Adult Dental, Pet Therapy
  • 11. 

    Managed care (health plans) allows a member to

    • Receive services from doctors that accept straight Medicaid.

    • See a primary care provider that will coordinate their overall care and will be referred to a specialist if needed.

    • Call the AHCA Medicaid Helpline concerning their benefits and questions.

    • See any primary care provider and specialists under any plan in their current region.

    Correct Answer
    A. See a primary care provider that will coordinate their overall care and will be referred to a specialist if needed.
  • 12. 

    Recipients that qualify for the MMA and LTC program can choose to have two different plans to receive services or can choose to have one plan that will provide LTC and MMA services. What type of plan is this?

    • Continuity of Care

    • Comprehensive Care Plan

    • Coordination of Dual Eligibles

    • CARES Assessment

    Correct Answer
    A. Comprehensive Care Plan
  • 13. 

    For the LTC program, enrollees that are in a "temporary loss" period will

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

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

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

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

    Correct Answer
    A. Continue receiving services from the LTC plan for up to 60 days and cannot change plans.
  • 14. 

    A direct service provider is

    • A company that has been approved to work for the LTC plan to provide long-term care services to enrollees.

    • A company that has been approved to provide medical services to enrollees.

    • A company that provides services to children with special medical needs.

    • A company that has been approved to provide services for individuals that are 65 years old or older.

    Correct Answer
    A. A company that has been approved to work for the LTC plan to provide long-term care services to enrollees.
  • 15. 

    After enrolling into a LTC plan, additional assistance and coordination of care will be provided through a ______________

    • DCF case worker who will meet with enrollees to perform an assessment, develop a plan of care, and assist the enrollee in obtaining appropriate care.

    • Care coordinator/case manager who will meet with enrollees to perform an assessment, develop a plan of care, and assist the enrollee in obtaining appropriate care.

    • Care coordinator/case manager who will provide long-term care services that are needed.

    • DCF case worker who will provide information to enrollees or thier families to help them choose a direct service provider.

    Correct Answer
    A. Care coordinator/case manager who will meet with enrollees to perform an assessment, develop a plan of care, and assist the enrollee in obtaining appropriate care.
  • 16. 

    The CARES assessment is required to

    • Establish Medicaid eligibility and verification of assets.

    • Recommend the least restrictive, safe, and most appropriate placement, identify the Level of Care, and long-term care needs.

    • Determine if the recipient will qualify for disability with the SSA or for workers compensation.

    • Identify if the recipient qualifies for services under the Agency for Persons with Disabilities.

    Correct Answer
    A. Recommend the least restrictive, safe, and most appropriate placement, identify the Level of Care, and long-term care needs.
  • 17. 

    For details about benefits or prior authorizations that are not listed on the plan brochure, the recipient must call:

    • AHCA

    • The plan

    • DCF

    • SSA

    Correct Answer
    A. The plan
  • 18. 

    The care coordinator/case manager will:

    • Become the Power of Attorney and make changes to the recipients case.

    • Develop a plan of care, assign direct services providers, and perform an assessment.

    • Determine if the recipient would qualify for food stamps and cash assistance.

    • Perform a CARES assessment to determine the level of care.

    Correct Answer
    A. Develop a plan of care, assign direct services providers, and perform an assessment.
  • 19. 

    What is the difference between LTC and MMA?

    • MMA will provide medical services; LTC will provide long-term care services.

    • There is no difference.

    • MMA is secondary to any LTC services.

    • LTC will cover all services MMA doesn't cover.

    Correct Answer
    A. MMA will provide medical services; LTC will provide long-term care services.
  • 20. 

    When is the last day a member can complete a plan change to be effective the following month?

    • Is the Thursday before the 2nd to the last Saturday of the month before 11:59pm.

    • Is the second to the last day of the month before 11:59pm.

    • Is the last day of the month before 11:59pm.

    Correct Answer
    A. Is the last day of the month before 11:59pm.
  • 21. 

    Which of the following listed below is not a Prohibited Activity?

    • Agent states: "Yes, this long-term care plan will best meet all of your needs."

    • Agent states: "My grandmother has that plan, you'd probably like it too."

    • Agent states: " You'd get more services and better doctors with this plan."

    • Agent states: "All MMA plans offer dental services. Contact the plan to find out more information about dental services."

    Correct Answer
    A. Agent states: "All MMA plans offer dental services. Contact the plan to find out more information about dental services."
  • 22. 

    Open enrollment is ______days.

    • 60

    • 90

    • 120

    • 180

    Correct Answer
    A. 60
  • 23. 

    Susie Smith is part of a waiver and wants to enroll into LTC.  How should you proceed?

    • Enroll Susie into an LTC plan

    • Refer Susie to the SSA

    • Refer Susie to DOEA to get screened for LTC

    • Refer Susie to her Primary Care Doctor

    Correct Answer
    A. Refer Susie to DOEA to get screened for LTC
  • 24. 

    Susie Smith qualifies for a managed care plan under LTC and MMA, what would you tell Susie about her plan options?

    • Tell Susie its her choice and you cannot provide any information.

    • Tell Susie she is eligible for a comprehensive plan, she is eligible to enroll into the same plan for both programs.

    • Tell Susie she can go on the website to review her plan enrollment options.

    • Tell Susie she can go to the senior center and someone will help her choose a plan.

    Correct Answer
    A. Tell Susie she is eligible for a comprehensive plan, she is eligible to enroll into the same plan for both programs.
  • 25. 

    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? 

    • "Since this is free medical care, once you enroll you cannot change it."

    • "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."

    • "Once you enroll, you will be in a no change period, and you will not be able to change the plan."

    • "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
    A. "Don't worry, you have 120 days to change the plan for any reason. Call us back if you want to change the plan."
  • 26. 

    Jonas Ruiz wants to know if the MMA managed care plan covers a root canal, how do you proceed?

    • Tell the caller dental for adults is not covered.

    • Tell the caller to call the Agency for Healthcare Administration.

    • Tell the caller all dental is covered by Medicaid.

    • Review the extra benefits on the brochure to see if it's listed, if not listed refer to the plan.

    Correct Answer
    A. Review the extra benefits on the brochure to see if it's listed, if not listed refer to the plan.
  • 27. 

    Susie Smith is enrolled in long-term care and wants to change the company that provides her home delivered meals.  How do you proceed?

    • Tell Susie to call the care coordinator at the plan.

    • Tell Susie to call DOEA.

    • Tell Susie she cannot change direct service providers.

    • Tell Susie she can change the provider during open enrollment.

    Correct Answer
    A. Tell Susie to call the care coordinator at the plan.
  • 28. 

    For MMA, Recipients 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 previous (if available).

    • No change

    • Open enrollment

    • Temporary loss

    • Lock-In

    Correct Answer
    A. Temporary loss
  • 29. 

    What is a Co-Payment?

    • A small amount paid by the enrollee to the provider for each visit or treatment. Co-pays range from $1-$3.

    • A small amount paid by the plan to the provider for each visit or treatment. Co-pays can be any amount.

    • A set amount of money paid by AHCA to the plan for each visit or treatment. Co-pays are set by the plan.

    • A percentage paid by the enrollee to the plan for each visit or treatment. Co-pays can vary in amount.

    Correct Answer
    A. A small amount paid by the enrollee to the provider for each visit or treatment. Co-pays range from $1-$3.
  • 30. 

    What is the process in which people will be directed to a different website than SMMC, to choose a Medicaid managed care health plan after completing the Medicaid application with the Department of Children and Families (DCF) called?

    • Eligibility

    • Recertification

    • Express Enrollment

    • Reinstatement

    Correct Answer
    A. Express Enrollment
  • 31. 

    Recipients who are enrolled in other waivers or programs like Project AIDS Care (PAC) Waiver and Model Waiver (age 18-20) may choose to enroll into the LTC program, but are not required. What options do these recipients have?

    • These recipients must stay on their current waiver to receive services until it runs out and then apply to receive services through a long-term care plan.

    • These recipients can stay on their current waiver to receive services or can leave the waiver and receive services through fee-for-service Medicaid.

    • These recipients can stay on their current waiver and also receive the same services through a long-term care plan.

    • These recipients can stay on their current waiver to receive services or can leave the waiver and receive services through a long-term care plan.

    Correct Answer
    A. These recipients can stay on their current waiver to receive services or can leave the waiver and receive services through a long-term care plan.
  • 32. 

    Which department administers the Medicaid program and has offices throughout the state to assist Medicaid recipients?

    • Department of Elder Affairs

    • Social Security Administration

    • The Agency for Health Care Administration

    • Florida Legislature

    Correct Answer
    A. The Agency for Health Care Administration
  • 33. 

    Under which of the following categories is the member required to be enrolled in managed care?

    • Mandatory

    • Voluntary

    • Excluded

    Correct Answer
    A. Mandatory
  • 34. 

    Changes during the following time periods will be granted another 120 day change period:

    • Changes during Open Enrollment and Reinstatements will be granted another 120 day change period.

    • Changes during 120 days and changes with Good Cause will be granted another 120 day change period.

    • Changes during the 60 day open enrollment will be granted another 120 day change period.

    Correct Answer
    A. Changes during 120 days and changes with Good Cause will be granted another 120 day change period.
  • 35. 

    A Mandatory recipient has the choice to enroll in a managed care plan or receive services through FFS/straight Medicaid.

    • True

    • False

    Correct Answer
    A. False
  • 36. 

    LTC recipients that experience a temporary loss of eligibility should:

    • Call DOEA to request an extension on their Medicaid eligibility.

    • Call the LTC plan to find out about their Medicaid eligibility before the 60 days are over.

    • Make plans to find another facility since they are losing Medicaid eligibility.

    • Call DCF or SSA to find out about their Medicaid eligibility status before the 60 days are over.

    Correct Answer
    A. Call DCF or SSA to find out about their Medicaid eligibility status before the 60 days are over.
  • 37. 

    A 13 year old child has severe mental and physical disabilities, would the child qualify for LTC? 

    • Yes, the child would qualify for LTC, because children get all medically necessary services.

    • No, the child must live in a nursing home in order to qualify for LTC.

    • No, because they must be at least 18 years of age.

    • Yes, people with disabilities may qualify for LTC.

    Correct Answer
    A. No, because they must be at least 18 years of age.
  • 38. 

    How can recipients enroll?

    • Call, Mail, Text, In Person

    • Call, Online, IVR, In person

    • Mail, Online, Send a Fax

    • Call, Text, Mail, Fax

    Correct Answer
    A. Call, Online, IVR, In person
  • 39. 

    Once enrolled, recipients must see providers that participate with their managed care plan.

    • True

    • False

    Correct Answer
    A. True
  • 40. 

    What does SMMC stand for?

    • Selective Medicaid Management Care

    • Statewide Medicaid Managed Care

    • Standard Managed Medical Complete

    • Statewide Managed Medical Core

    Correct Answer
    A. Statewide Medicaid Managed Care

Quiz Review Timeline (Updated): Mar 16, 2022 +

Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.

  • Current Version
  • Mar 16, 2022
    Quiz Edited by
    ProProfs Editorial Team
  • Dec 27, 2013
    Quiz Created by
    AHSFLTrainer
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