Smmc: Program Information Quiz

1. 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

2. 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."

3. 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

4. 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.

5. 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 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.

6. 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.

7. 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."

8. 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.

9. 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

10. What does SMMC stand for?

Selective Medicaid Management Care

Statewide Medicaid Managed Care

Standard Managed Medical Complete

Statewide Managed Medical Core

11. 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.

12. 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.

13. 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.

14. 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.

15. 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

16. 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.

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

KidCare Applicants

DCF Applicants

SSA Applicants

WIC Applicants

18. 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.

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

180

90

120

30

20. 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.

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

AHCA

The plan

DCF

SSA

22. 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

23. 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

24. 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.

25. Which agencies determine Medicaid eligibility?

DCF and SSA

Elder Affairs and CARES

HMO's and PSN's

AHCA and DOEA

26. Fee-For-Service is also known as

Pre-Paid Medicaid

Straight Medicaid

Medically Needy

Basic Services

27. 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

28. 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.

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

Mandatory

Voluntary

Excluded

30. 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

31. 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.

32. 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.

33. How can recipients enroll?

Call, Mail, Text, In Person

Call, Online, IVR, In person

Mail, Online, Send a Fax

Call, Text, Mail, Fax

34. Open enrollment is ______days.

60

90

120

180

35. 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.

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

True

False

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

True

False

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

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

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

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.

Smmc: Program Information Quiz

1. 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).

2.

What first name or nickname would you like us to use?

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

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

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

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

6. What is the difference between LTC and MMA?

7. 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?

8. LTC recipients that experience a temporary loss of eligibility should:

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

10. What does SMMC stand for?

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

12. The Special Needs Unit consists of

13. For entry into the LTC program you must:

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

15. 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?

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

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

18. Express Enrollments will be effective

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

20. The CARES assessment is required to

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

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

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

24. The care coordinator/case manager will:

25. Which agencies determine Medicaid eligibility?

26. Fee-For-Service is also known as

27. Which are examples of extra (expanded) benefits?

28. Managed care (health plans) allows a member to

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

30. 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?

31. A direct service provider is

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

33. How can recipients enroll?

34. Open enrollment is ______days.

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

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

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

38. What is a Co-Payment?

39. 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?

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