Specialty Plan Sensitivity Quiz

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.

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.

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

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.

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.

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.

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.

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.

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.

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.