Smmc: Program Information Quiz

40 Questions | Total Attempts: 1134

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Programming Quizzes & Trivia

Questions and Answers
  • 1. 
    The Special Needs Unit consists of
    • A. 

      CMS case workers.

    • B. 

      Trained nurses skilled to assist with children with special needs.

    • C. 

      Trained nurses staffed to help AHS employees with their complex medical needs.

    • D. 

      Trained nurses staffed to assist recipients with complex medical needs.

  • 2. 
    Which applicant below will be directed to use the Express Enrollment website?
    • A. 

      KidCare Applicants

    • B. 

      DCF Applicants

    • C. 

      SSA Applicants

    • D. 

      WIC Applicants

  • 3. 
    Express Enrollments will be effective
    • A. 

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

    • B. 

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

    • C. 

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

    • D. 

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

  • 4. 
    Recipients will have  __________ days to change the plan without a Good Cause Reason.
    • A. 

      180

    • B. 

      90

    • C. 

      120

    • D. 

      30

  • 5. 
    For entry into the LTC program you must:
    • A. 

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

    • B. 

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

    • C. 

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

    • D. 

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

  • 6. 
    What are the two components that make up the Statewide Medicaid Managed Care Program?
    • A. 

      AHCA and The Florida Legislature

    • B. 

      DCF & SSA

    • C. 

      LTC & MMA

    • D. 

      LTC & CARES

  • 7. 
    Which of the following services is not provided by the Long Term Care program?
    • A. 

      Respite Care

    • B. 

      Adult Day Healthcare

    • C. 

      Home Delivered Meals

    • D. 

      Prescription Medication

    • E. 

      Assisted Living

  • 8. 
    Which agencies determine Medicaid eligibility?
    • A. 

      DCF and SSA

    • B. 

      Elder Affairs and CARES

    • C. 

      HMO's and PSN's

    • D. 

      AHCA and DOEA

  • 9. 
    Fee-For-Service is also known as
    • A. 

      Pre-Paid Medicaid

    • B. 

      Straight Medicaid

    • C. 

      Medically Needy

    • D. 

      Basic Services

  • 10. 
    Which are examples of extra (expanded) benefits?
    • A. 

      Prescriptions, Check Ups, Laboratory, X Rays

    • B. 

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

    • C. 

      Surgery, Birthing Center Services, Hospice Services

    • D. 

      Emergency Services, Transportation, Podiatric Services

  • 11. 
    Managed care (health plans) allows a member to
    • A. 

      Receive services from doctors that accept straight Medicaid.

    • B. 

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

    • C. 

      Call the AHCA Medicaid Helpline concerning their benefits and questions.

    • D. 

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

  • 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?
    • A. 

      Continuity of Care

    • B. 

      Comprehensive Care Plan

    • C. 

      Coordination of Dual Eligibles

    • D. 

      CARES Assessment

  • 13. 
    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.

  • 14. 
    A direct service provider is
    • A. 

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

    • B. 

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

    • C. 

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

    • D. 

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

  • 15. 
    After enrolling into a LTC plan, additional assistance and coordination of care will be provided through a ______________
    • 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.

    • B. 

      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.

    • C. 

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

    • D. 

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

  • 16. 
    The CARES assessment is required to
    • A. 

      Establish Medicaid eligibility and verification of assets.

    • B. 

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

    • C. 

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

    • D. 

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

  • 17. 
    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

  • 18. 
    The care coordinator/case manager will:
    • A. 

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

    • B. 

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

    • C. 

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

    • D. 

      Perform a CARES assessment to determine the level of care.

  • 19. 
    What is the difference between LTC and MMA?
    • A. 

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

    • B. 

      There is no difference.

    • C. 

      MMA is secondary to any LTC services.

    • D. 

      LTC will cover all services MMA doesn't cover.

  • 20. 
    When is the last day a member can complete a plan change to be effective the following month?
    • A. 

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

    • B. 

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

    • C. 

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

  • 21. 
    Which of the following listed below is not a Prohibited Activity?
    • A. 

      Agent states: "Yes, this long-term care 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 MMA plans offer dental services. Contact the plan to find out more information about dental services."

  • 22. 
    Open enrollment is ______days.
    • A. 

      60

    • B. 

      90

    • C. 

      120

    • D. 

      180

  • 23. 
    Susie Smith is part of a waiver and wants to enroll into LTC.  How should you proceed?
    • A. 

      Enroll Susie into an LTC plan

    • B. 

      Refer Susie to the SSA

    • C. 

      Refer Susie to DOEA to get screened for LTC

    • D. 

      Refer Susie to her Primary Care Doctor

  • 24. 
    Susie Smith qualifies for a managed care plan under LTC and MMA, what would you tell Susie about her plan options?
    • A. 

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

    • B. 

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

    • C. 

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

    • D. 

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

  • 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? 
    • 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."

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