Specialty Plan Sensitivity Quiz

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Quizzes Created: 27 | Total Attempts: 16,543
Questions: 10 | Attempts: 463

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Questions and Answers
  • 1. 

    What is a MMA Specialty Plan?

    • A.

      A plan for recipients in a special region.

    • B.

      A new type of plan that will serve all Medicaid recipients.

    • C.

      A plan that will serve Medicaid recipients who have special needs based on age, medical conditions, or diagnosis.

    • D.

      A plan for the elderly and disabled recipients only.

    Correct Answer
    C. A plan that will serve Medicaid recipients who have special needs based on age, medical conditions, or diagnosis.
    Explanation
    A MMA Specialty Plan is a type of plan that is specifically designed to cater to the special needs of Medicaid recipients based on their age, medical conditions, or diagnosis. This plan aims to provide specialized care and support to individuals who require extra attention and services due to their unique circumstances. It is not limited to a specific region or demographic, but rather focuses on addressing the specific needs of Medicaid recipients with special requirements.

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  • 2. 

    Recipients with the following special conditions listed on file will be able to enroll into a specialty plan designed to meet their specific condition:(Check ALL the apply)

    • A.

      LTC Non-COMP

    • B.

      Child Welfare (HOMESAFENET)

    • C.

      HIV/AIDS

    • D.

      Children's Medical Services (CMS)

    • E.

      Serious Mental Illness (SMI)

    • F.

      Diabetes, Cardiovascular Disease, Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF)

    Correct Answer(s)
    B. Child Welfare (HOMESAFENET)
    C. HIV/AIDS
    D. Children's Medical Services (CMS)
    E. Serious Mental Illness (SMI)
    F. Diabetes, Cardiovascular Disease, Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF)
    Explanation
    Recipients with special conditions such as Child Welfare (HOMESAFENET), HIV/AIDS, Children's Medical Services (CMS), Serious Mental Illness (SMI), and chronic diseases like Diabetes, Cardiovascular Disease, Chronic Obstructive Pulmonary Disease (COPD), and Congestive Heart Failure (CHF) will be eligible to enroll in a specialty plan tailored to meet their specific condition. This means that individuals with these conditions will have access to a specialized healthcare plan that addresses their unique needs and provides appropriate care and support.

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  • 3. 

    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

    Correct Answer
    B. Sunshine Health Child Welfare Plan
    Explanation
    Recipients with HOMESAFENET as an active special condition are eligible to enroll into the Sunshine Health Child Welfare Plan. This plan specifically caters to the needs of children in the child welfare system, ensuring they receive comprehensive healthcare services. Therefore, it is the appropriate specialty plan for recipients with the HOMESAFENET special condition.

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  • 4. 

    Recipients with an active Serious Mental Illness special condition on file are eligible to enroll into which specialty plan?

    • A.

      Prestige Health Choice

    • B.

      Clear Health Alliance

    • C.

      Molina Health Care of Florida

    • D.

      Magellan Complete Care

    Correct Answer
    D. Magellan Complete Care
    Explanation
    Recipients with an active Serious Mental Illness special condition on file are eligible to enroll into Magellan Complete Care. This suggests that Magellan Complete Care is a specialty plan specifically designed to cater to the needs of individuals with serious mental illnesses. The other options, Prestige Health Choice, Clear Health Alliance, and Molina Health Care of Florida, may not have the same level of specialization or focus on mental health conditions.

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  • 5. 

    The member calls in and says: "I saw my specialist yesterday and he said I needed to enroll into some special plan. I also received a letter in the mail saying I can enroll into a plan that will help with my....condition. I live with my parents. Will you just enroll me into this plan so I can stop hearing about it and receiving stuff in the mail?How do you help this member?

    • A.

      Ask the member to tell you their condition; repeat the condition to confirm you heard them correctly, and explain to them they can only enroll into the specialty plan addressed in the letter.

    • B.

      Ask: "Do you have any special medical needs such as pregnancy or HIV/AIDS?" Document the special need and provide all plan options available in the member's region.

    • C.

      Tell the member to ignore the letters because they can enroll in to any plan in the region.

    • D.

      Say: "If you have HIV/AIDS the best plans for your condition are Clear Health Alliance or Positive Health Choice."

    Correct Answer
    B. Ask: "Do you have any special medical needs such as pregnancy or HIV/AIDS?" Document the special need and provide all plan options available in the member's region.
    Explanation
    The correct answer is to ask the member if they have any special medical needs such as pregnancy or HIV/AIDS, document the special need, and provide all plan options available in the member's region. This is the appropriate response because it ensures that the member's specific medical needs are taken into consideration when enrolling them into a plan. By documenting the special need and providing all plan options, the member can make an informed decision based on their condition and choose the most suitable plan for their needs.

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  • 6. 

    The member calls in and says: "I ne-ne-need to ask you a fe-fe-few que-que-questions. Can you se-se-see if my therapist ta-ta-takes this spe-spe-special plan? Whe-when will this plan st-st-st-start? Will I re-re-receive a ca-ca-card soon?How would you help this member?

    • A.

      Ask the caller if there is someone else around that speaks more clearly.

    • B.

      Ask the member to hold and call PA Language Line for assistance.

    • C.

      Transfer to a supervisor.

    • D.

      Be understanding to the member's condition, actively listen, and repeat what you heard for clarification.

    Correct Answer
    D. Be understanding to the member's condition, actively listen, and repeat what you heard for clarification.
    Explanation
    The correct answer is to be understanding to the member's condition, actively listen, and repeat what you heard for clarification. The member is experiencing a speech impediment, as indicated by the repetition of certain sounds. Instead of assuming the member is unintelligible, it is important to show empathy and patience. By actively listening and repeating what was heard, the member can confirm if their therapist accepts the special plan, when it starts, and when they will receive a card. This approach demonstrates good customer service and ensures that the member's needs are addressed effectively.

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  • 7. 

    You ask a parent: "Does your child have any special medical needs?"Parent response: "No, but he has a hard time paying attention in school. He's always getting in trouble but I think it's because his father passed away. His teacher thinks he needs some type of therapy. But no medical needs."How would you help this member?

    • A.

      Disregard the extra information stated by the parent and proceed with the call since the parent answered "No".

    • B.

      Document the child needs therapy without the parent's knowledge and just refer the parent to CMS for further explaination.

    • C.

      Advise the caller, "According to the information provided your child may qualify for CMS." Proceed with asking the caller the CMS screening questions.

    • D.

      Explain to the parent the child might need to enroll into CMS since the teacher said the child needs therapy.

    Correct Answer
    C. Advise the caller, "According to the information provided your child may qualify for CMS." Proceed with asking the caller the CMS screening questions.
    Explanation
    The correct answer is to advise the caller that their child may qualify for CMS based on the information provided. This is because the parent mentioned that the child needs some type of therapy according to the teacher. By suggesting that the child may qualify for CMS, the caller can proceed with asking the CMS screening questions to determine if the child is eligible for any assistance or support.

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  • 8. 

    Recipients with an active HIV/AIDS special condition are eligible to enroll into which specialty plan?

    • A.

      Magellan Complete Care

    • B.

      Positive Healthcare

    • C.

      Children's Medical Services

    • D.

      Sunshine Health

    Correct Answer
    B. Positive Healthcare
    Explanation
    Recipients with an active HIV/AIDS special condition are eligible to enroll into Positive Healthcare.

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  • 9. 

    A DCF/CBC Caseworker calls in and says: I have a case load of children I am calling about. They all need to be enrolled into a plan so they can receive serves immediately because some of them have special medical needs. They all live in different cities, with different families; however, I have all of the information you will need.How do you help this caller?

    • A.

      Explain to the Caseworker that you are only allowed to access one case per phone call.

    • B.

      Focus on enrolling the children into the correct plan; one case at a time. Be patient and keep in mind the call could take a little more time.

    • C.

      Place the caseworker on hold and take time to gather yourself because this call is going to take a long time.

    • D.

      Caseworkers with multiple enrollments should complete them on the website only.

    Correct Answer
    B. Focus on enrolling the children into the correct plan; one case at a time. Be patient and keep in mind the call could take a little more time.
    Explanation
    The correct answer suggests that the caller should focus on enrolling the children into the correct plan one case at a time. This implies that the caseworker should prioritize each child's needs individually and ensure that they are enrolled in a plan that caters to their specific medical needs. The answer also emphasizes the need for patience and acknowledges that the call may take longer due to the multiple cases. This approach ensures that each child receives the necessary services promptly and efficiently.

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  • 10. 

    A member's family member calls in and says: My brother just received a letter in the mail about enrolling into a plan called Clear Health Alliance. Can you tell me what kind of plan this is because my children did not get this option?  Is it a plan for just adults or does he have something I do not know about?How do you help this caller?

    • A.

      Explain to the caller that Clear Health Alliance is a plan for members with an active HIV/AIDS special condition on file and her brother received the letter to inform him about his plan options.

    • B.

      Tell the member she needs to talk to her brother about his personal business.

    • C.

      Tell the caller you will send her an enrollment package with information about the plan because you cannot talk about the plan over the phone.

    • D.

      Say: "If your brother received this letter, that means he has HIV/AIDS. Didn't he tell you?

    Correct Answer
    A. Explain to the caller that Clear Health Alliance is a plan for members with an active HIV/AIDS special condition on file and her brother received the letter to inform him about his plan options.
    Explanation
    The correct answer is to explain to the caller that Clear Health Alliance is a plan for members with an active HIV/AIDS special condition on file and her brother received the letter to inform him about his plan options. This answer provides the necessary information to address the caller's question and clarify the purpose of the plan. It also shows understanding and empathy towards the caller's concern by providing a clear explanation.

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

  • Current Version
  • Mar 20, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Aug 12, 2014
    Quiz Created by
    AHSFLTrainer
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