Specialty Plan Sensitivity Quiz

10 Questions | Total Attempts: 419

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Specialty Plan Sensitivity Quiz


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.

  • 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)

  • 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

  • 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

  • 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."

  • 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.

  • 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.

  • 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

  • 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.

  • 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?

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