2018 Fl Smmc Program Overview Quiz

Approved & Edited by ProProfs Editorial Team
The editorial team at ProProfs Quizzes consists of a select group of subject experts, trivia writers, and quiz masters who have authored over 10,000 quizzes taken by more than 100 million users. This team includes our in-house seasoned quiz moderators and subject matter experts. Our editorial experts, spread across the world, are rigorously trained using our comprehensive guidelines to ensure that you receive the highest quality quizzes.
Learn about Our Editorial Process
| By AHSFLTrainer
A
AHSFLTrainer
Community Contributor
Quizzes Created: 30 | Total Attempts: 16,659
Questions: 40 | Attempts: 235

SettingsSettingsSettings
2018 Fl Smmc Program Overview Quiz - Quiz

Program Overview Quiz


Questions and Answers
  • 1. 

    Fee-For-Service is also known as:

    • A.

      • Pre-Paid Medicaid

    • B.

      • Straight Medicaid

    • C.

      • Medically Needy

    • D.

      • Basic Services

    Correct Answer
    B. • Straight Medicaid
    Explanation
    Fee-For-Service is also known as Straight Medicaid because it refers to a payment model where healthcare providers are reimbursed for each service they provide to patients. In this system, healthcare services are paid for individually, rather than through a fixed monthly payment or pre-paid plan. Straight Medicaid allows patients to choose their healthcare providers and receive the necessary services without restrictions or limitations.

    Rate this question:

  • 2. 

    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

    Correct Answer
    B. • Over the Counter Items, Circumcision, Adult Dental, Pet Therapy
    Explanation
    The examples listed in the answer are all additional benefits that go beyond the basic medical services typically covered by insurance. Over the Counter Items, Circumcision, Adult Dental, and Pet Therapy are not typically covered by standard health insurance plans, but they provide extra value and support for individuals. These benefits can help improve overall well-being and provide additional options for individuals seeking specialized care or alternative treatments.

    Rate this question:

  • 3. 

    When is the last day an enrollee 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.

    Correct Answer
    C. • is the last day of the month before 11:59pm.
    Explanation
    The last day an enrollee can complete a plan change to be effective the following month is the last day of the month before 11:59pm. This means that if an enrollee wants their plan change to take effect in February, for example, they must complete the change by the last day of January before 11:59pm.

    Rate this question:

  • 4. 

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

    • A.

      • Department of Elder Affairs

    • B.

      • Social Security Administration

    • C.

      • The Agency for Health Care Administration

    • D.

      • Florida Legislature

    Correct Answer
    C. • The Agency for Health Care Administration
    Explanation
    The correct answer is the Agency for Health Care Administration. This department is responsible for administering the Medicaid program and has offices throughout the state to assist Medicaid recipients. The Department of Elder Affairs focuses on issues related to the elderly, the Social Security Administration handles social security benefits, and the Florida Legislature is responsible for making laws in the state of Florida.

    Rate this question:

  • 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.

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

    • C.

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

    • D.

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

    Correct Answer
    A. • Be at least 18 years old, File for financial eligibility and Meet the required Level of Care.
    Explanation
    The correct answer is the first option, which states that in order to enter the LTC program, one must be at least 18 years old, file for financial eligibility, and meet the required level of care. This means that individuals must meet certain financial criteria and have a documented need for long-term care services. Age is also a factor, as the program is only available to those who are at least 18 years old.

    Rate this question:

  • 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

    Correct Answer
    C. • LTC & MMA
    Explanation
    The two components that make up the Statewide Medicaid Managed Care Program are LTC (Long-Term Care) and MMA (Managed Medical Assistance).

    Rate this question:

  • 7. 

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

    • A.

      • KidCare Applicants

    • B.

      • DCF Applicants

    • C.

      • SSA Applicants

    • D.

      • WIC Applicants

    Correct Answer
    B. • DCF Applicants
    Explanation
    DCF (Department of Children and Families) Applicants will be directed to use the Express Enrollment website. This is because the Express Enrollment website is likely specifically designed for DCF applicants to streamline the enrollment process and provide them with the necessary information and resources.

    Rate this question:

  • 8. 

    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.

    Correct Answer
    C. • continue receiving services from the LTC plan for up to 60 days and cannot change plans.
    Explanation
    Enrollees in the LTC program who are experiencing a "temporary loss" period will be able to continue receiving services from the LTC plan for a maximum period of 60 days. However, during this time, they will not have the option to change plans. This means that they cannot switch to a different LTC plan if they choose to. They will still be able to receive the necessary services from their current LTC plan during this temporary loss period.

    Rate this question:

  • 9. 

    What is the process in which people will be directed to another website to choose a Medicaid managed care health plan after completing the Medicaid application with the Department of Children and Families (DCF) called?

    • A.

      • Eligibility

    • B.

      • Recertification

    • C.

      • Express Enrollment

    • D.

      • Reinstatement

    Correct Answer
    C. • Express Enrollment
    Explanation
    Express Enrollment is the process in which people will be directed to another website to choose a Medicaid managed care health plan after completing the Medicaid application with the Department of Children and Families (DCF).

    Rate this question:

  • 10. 

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

    • A.

      • Tell the caller dental for adults is not covered.

    • B.

      • Tell the caller to call the Agency for Healthcare Administration.

    • C.

      • Tell the caller all dental is covered by Medicaid.

    • D.

      • Review the extra benefits on the brochure to see if it's listed, if not listed refer to the plan.

    Correct Answer
    D. • Review the extra benefits on the brochure to see if it's listed, if not listed refer to the plan.
    Explanation
    The correct answer is to review the extra benefits on the brochure to see if a root canal is listed. If it is not listed, then the caller should refer to the plan for more information. This approach allows for a thorough examination of the available benefits and ensures that the caller receives accurate information about coverage for a root canal.

    Rate this question:

  • 11. 

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

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Once enrolled in a managed care plan, enrollees are required to see providers who are part of the network and participate in the plan. This is because managed care plans negotiate contracts with specific healthcare providers to ensure that enrollees receive the appropriate care within the network. Seeing providers outside of the network may result in higher out-of-pocket costs or may not be covered at all. Therefore, it is true that enrollees must see providers that participate with their managed care plan.

    Rate this question:

  • 12. 

    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 enrollees with complex medical needs.

    Correct Answer
    D. • trained nurses staffed to assist enrollees with complex medical needs.
    Explanation
    The Special Needs Unit includes trained nurses who are specifically assigned to assist enrollees with complex medical needs. These nurses have the necessary skills and training to provide the required care and support to individuals with complex medical conditions. They are likely to have a deep understanding of the unique needs and challenges faced by enrollees with complex medical needs and are equipped to provide the appropriate assistance and care.

    Rate this question:

  • 13. 

    How can recipients enroll? 

    • A.

      • Call, Mail, Text, In Person

    • B.

      • Call, Online, IVR, In person

    • C.

      • Mail, Online, Send a Fax

    • D.

      • Call, Text, Mail, Fax

    Correct Answer
    B. • Call, Online, IVR, In person
    Explanation
    Recipients can enroll in multiple ways: they can call a designated phone number, enroll online through a website, use an interactive voice response (IVR) system, or enroll in person. These options provide flexibility and convenience for recipients to choose the enrollment method that suits them best.

    Rate this question:

  • 14. 

    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."

    Correct Answer
    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."
    Explanation
    The correct answer is "Don't worry, you have 120 days to change the plan for any reason. Call us back if you want to change the plan." This answer reassures Sonia that she has a window of 120 days to change her plan if she is not satisfied with it. It offers her flexibility and the opportunity to explore other options within a reasonable timeframe.

    Rate this question:

  • 15. 

    Managed care (health plans) allows a recipient 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.

    Correct Answer
    B. • See a primary care provider that will coordinate their overall care and will be referred to a specialist if needed.
    Explanation
    Managed care allows a recipient to see a primary care provider who will coordinate their overall care and refer them to a specialist if necessary. This means that the recipient will have a designated healthcare professional who will oversee their medical needs and ensure that they receive appropriate and timely referrals to specialists when required. This arrangement helps to streamline and coordinate the recipient's healthcare, ensuring that they receive comprehensive and well-coordinated care.

    Rate this question:

  • 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? 

    • A.

      • Tell Susie to call the care coordinator at the plan.

    • B.

      • Tell Susie to call DOEA.

    • C.

      • Tell Susie she cannot change direct service providers.

    • D.

      • Tell Susie she can change the provider during open enrollment.

    Correct Answer
    A. • Tell Susie to call the care coordinator at the plan.
    Explanation
    Susie Smith should be advised to call the care coordinator at the plan because they are responsible for managing her Long-Term Care and can assist her in changing the company that provides her home delivered meals.

    Rate this question:

  • 17. 

    LTC enrollees that experience a temporary loss of eligibility should: 

    • A.

      • Call DOEA to request an extension on their Medicaid eligibility.

    • B.

      • Call the LTC plan to find out about their Medicaid eligibility before the 60 days are over.

    • C.

      • 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.

    • D.

      • Call DCF or SSA to find out about their Medicaid eligibility status before the 60 days are over.

    Correct Answer
    D. • Call DCF or SSA to find out about their Medicaid eligibility status before the 60 days are over.
    Explanation
    The correct answer is to call DCF or SSA to find out about their Medicaid eligibility status before the 60 days are over. This is because DCF (Department of Children and Families) and SSA (Social Security Administration) are the agencies responsible for determining Medicaid eligibility. By contacting them, LTC enrollees can get accurate information about their eligibility status and take appropriate actions within the given timeframe.

    Rate this question:

  • 18. 

    Enrollees 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

    Correct Answer
    B. • Comprehensive Care Plan
    Explanation
    A comprehensive care plan is a type of plan that allows enrollees to receive both long-term care (LTC) and Medicare and Medicaid Assistance (MMA) services. This plan provides a wide range of services and support to individuals who qualify for both programs. It ensures that all of their healthcare needs are addressed and coordinated effectively.

    Rate this question:

  • 19. 

    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 SSA

    • C.

      • Refer Susie to DOEA to get screened for LTC

    • D.

      • Refer Susie to her Primary Care Doctor

    Correct Answer
    C. • Refer Susie to DOEA to get screened for LTC
  • 20. 

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

    • A.

      • AHCA

    • B.

      • The Plan

    • C.

      • DCF

    • D.

      • SSA

    Correct Answer
    B. • The Plan
    Explanation
    The correct answer is "The Plan". This is because the question is asking about benefits or prior authorizations that are not listed on the plan brochure. In this case, the enrollee would need to contact the specific plan they are enrolled in to inquire about these details. The other options listed (AHCA, DCF, SSA) are not relevant to this specific question.

    Rate this question:

  • 21. 

    Recipients who are enrolled in other waivers or programs (Ex: Model Waiver - Age 18-20) may choose to enroll into the LTC program but are not required. What options do these recipients have? 

    • A.

      • These recipients must stay on their current waiver to receive services until it runs out and then apply to receive services through a long-term care plan.

    • B.

      • These recipients can stay on their current waiver to receive services or can leave the waiver and receive services through fee-for-service Medicaid.

    • C.

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

    • D.

      • These recipients can stay on their current waiver to receive services or can leave the waiver and receive services through a long-term care plan.

    Correct Answer
    D. • These recipients can stay on their current waiver to receive services or can leave the waiver and receive services through a long-term care plan.
    Explanation
    Recipients who are enrolled in other waivers or programs have the option to either stay on their current waiver and continue receiving services, or they can choose to leave the waiver and receive services through a long-term care plan. This means that they have the flexibility to decide which option works best for them in terms of accessing the necessary services.

    Rate this question:

  • 22. 

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

    • A.

      • Changes during Open Enrollment and Reinstatements will be granted another 120 day change period.

    • B.

      • Changes during the initial 120 days and Good Cause plan changes will be granted another 120 day change period.

    • C.

      • Changes during the 60 day open enrollment will be granted another 120 day change period.

    Correct Answer
    B. • Changes during the initial 120 days and Good Cause plan changes will be granted another 120 day change period.
    Explanation
    During the initial 120 days and Good Cause plan changes, individuals will be granted another 120-day change period. This means that if someone makes changes to their plan during the first 120 days or due to a Good Cause, they will have an additional 120 days to make further changes if needed. This allows individuals to have more flexibility and time to adjust their plan according to their needs and circumstances.

    Rate this question:

  • 23. 

    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 worker’s compensation.

    • D.

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

    Correct Answer
    B. • recommend the least restrictive, safe, and most appropriate placement, identify the Level of Care, and long-term care needs.
    Explanation
    The CARES assessment is required to recommend the least restrictive, safe, and most appropriate placement for individuals, as well as identify their Level of Care and long-term care needs. This assessment helps in determining the appropriate level of care and support services for individuals, ensuring that they receive the necessary care while maintaining their independence and safety. It is a comprehensive evaluation that takes into account various factors such as medical conditions, functional abilities, and support systems to determine the most suitable placement and level of care for the individual.

    Rate this question:

  • 24. 

    What does SMMC stand for? 

    • A.

      • Selective Medicaid Management Care

    • B.

      • Statewide Medicaid Managed Care

    • C.

      • Standard Managed Medical Complete

    • D.

      • Statewide Managed Medical Core

    Correct Answer
    B. • Statewide Medicaid Managed Care
    Explanation
    SMMC stands for Statewide Medicaid Managed Care. This program is designed to provide managed care services to Medicaid recipients in a specific state. It aims to improve the coordination and quality of healthcare services for Medicaid beneficiaries by contracting with managed care organizations (MCOs) to deliver and oversee their healthcare. This acronym is commonly used in the healthcare industry to refer to this specific program.

    Rate this question:

  • 25. 

    Enrollees will initially have  __________ days to change the plan without a Good Cause Reason. 

    • A.

      • 180

    • B.

      • 90

    • C.

      • 120

    • D.

      • 30

    Correct Answer
    C. • 120
    Explanation
    Enrollees will initially have 120 days to change the plan without a Good Cause Reason. This means that within the first 120 days of enrolling in the plan, individuals can make changes to their plan without needing to provide a valid reason for doing so. After this initial period, individuals may still be able to make changes, but they would need to have a Good Cause Reason for doing so.

    Rate this question:

  • 26. 

    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."

    Correct Answer
    D. • Agent states: "All MMA plans offer dental services. Contact the plan to find out more information about dental services."
    Explanation
    The given answer is not a prohibited activity because it provides accurate information about the dental services offered by MMA plans and encourages the individual to contact the plan for more information. This statement does not involve any false or misleading claims, unlike the other options which either make subjective statements or use personal anecdotes to persuade the individual.

    Rate this question:

  • 27. 

    Which agencies determine Medicaid eligibility? 

    • A.

      • DCF and SSA

    • B.

      • Elder Affairs and CARES

    • C.

      • HMO's and PSN's

    • D.

      • AHCA and DOEA

    Correct Answer
    A. • DCF and SSA
    Explanation
    DCF (Department of Children and Families) and SSA (Social Security Administration) are the agencies that determine Medicaid eligibility. DCF is responsible for determining eligibility for families and children, while SSA determines eligibility for individuals who are elderly or disabled. These agencies assess income, assets, and other factors to determine if an individual or family meets the requirements for Medicaid coverage.

    Rate this question:

  • 28. 

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

    • A.

      • Yes, the child would qualify for LTC, because children get all medically necessary services.

    • B.

      • No, the child must live in a nursing home in order to qualify for LTC.

    • C.

      • No, because they must be at least 18 years of age.

    • D.

      • Yes, people with disabilities may qualify for LTC.

    Correct Answer
    C. • No, because they must be at least 18 years of age.
  • 29. 

    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.

    Correct Answer
    A. • a company that has been approved to work for the LTC plan to provide long-term care services to enrollees.
    Explanation
    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. This means that the company has met the necessary qualifications and requirements to offer services specifically related to long-term care. They have been approved by the LTC plan, indicating that they have undergone a vetting process to ensure their ability to provide the necessary care and support to enrollees. This distinguishes them from other companies that may provide different types of medical services or services for specific age groups.

    Rate this question:

  • 30. 

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

    • A.

      • Tell Susie it’s her choice and you cannot provide any information.

    • B.

      • Tell Susie she is eligible for a comprehensive plan. Inform her that she has the option to enroll into the same plan for both programs, but is not required to.

    • 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.

    Correct Answer
    B. • Tell Susie she is eligible for a comprehensive plan. Inform her that she has the option to enroll into the same plan for both programs, but is not required to.
    Explanation
    The correct answer suggests that Susie is eligible for a comprehensive plan and has the option to enroll in the same plan for both LTC and MMA programs. However, it is not mandatory for her to do so. This implies that Susie has the flexibility to choose different plans for each program if she wishes.

    Rate this question:

  • 31. 

    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.

    Correct Answer
    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.
    Explanation
    After enrolling into a LTC plan, a care coordinator/case manager will be assigned to the enrollees. This individual will meet with the enrollees to assess their needs, develop a personalized plan of care, and assist them in obtaining the appropriate care. The care coordinator/case manager will provide additional assistance and coordination of care throughout the LTC plan, ensuring that the enrollees receive the necessary support and services they require. This individual plays a crucial role in ensuring the overall well-being and quality of care for the enrollees.

    Rate this question:

  • 32. 

    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.

    Correct Answer
    A. • MMA will provide medical services; LTC will provide Long-Term Care services.
    Explanation
    The correct answer explains that MMA (presumably referring to Medicare Advantage) will provide medical services, while LTC (presumably referring to Long-Term Care insurance) will provide long-term care services. This suggests that the two types of insurance have different coverage focuses, with MMA primarily covering medical expenses and LTC primarily covering long-term care expenses.

    Rate this question:

  • 33. 

    What is a Co-Payment? 

    • A.

      • a small amount paid by the enrollee to the provider for each visit or treatment. Co-pays range from $1-$3.

    • B.

      • a small amount paid by the plan to the provider for each visit or treatment. Co-pays can be any amount.

    • C.

      • a set amount of money paid by AHCA to the plan for each visit or treatment. Co-pays are set by the plan.

    • D.

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

    Correct Answer
    A. • a small amount paid by the enrollee to the provider for each visit or treatment. Co-pays range from $1-$3.
    Explanation
    A co-payment is a small amount of money that an enrollee pays directly to the healthcare provider for each visit or treatment. The co-pays typically range from $1 to $3. This payment is separate from any other costs or fees associated with the healthcare plan.

    Rate this question:

  • 34. 

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

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    The statement is false because a mandatory enrollee does not have the choice to enroll in a managed care plan or receive services through FFS/straight Medicaid. Mandatory enrollees are required to enroll in a managed care plan and are not given the option to choose FFS/straight Medicaid.

    Rate this question:

  • 35. 

    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 enrollee will have FFS for the first month.

    Correct Answer
    A. • when Medicaid is approved. The effective date can be any day of the month.
    Explanation
    Express Enrollments will be effective when Medicaid is approved. The effective date can be any day of the month, meaning that the coverage will begin immediately upon approval and does not need to wait until the first day of the following month. This allows for quicker access to healthcare services for the enrollee.

    Rate this question:

  • 36. 

    The care coordinator/case manager will: 

    • A.

      • Become the Power of Attorney and make changes to the enrollee’s case.

    • B.

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

    • C.

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

    • D.

      • Perform a CARES assessment to determine the level of care.

    Correct Answer
    B. • Develop a plan of care, assign direct services providers, and perform an assessment.
    Explanation
    The correct answer is "Develop a plan of care, assign direct services providers, and perform an assessment." This answer is correct because it accurately describes the role of a care coordinator or case manager. They are responsible for developing a comprehensive plan of care for the enrollee, which includes assigning direct service providers to meet their needs. Additionally, they perform assessments to evaluate the enrollee's condition and determine the appropriate level of care required.

    Rate this question:

  • 37. 

    Open enrollment is ______days. 

    • A.

      • 60

    • B.

      • 90

    • C.

      • 120

    • D.

      • 180

    Correct Answer
    A. • 60
    Explanation
    Open enrollment is typically a period of time during which individuals can enroll in or make changes to their health insurance coverage. The correct answer, 60 days, suggests that open enrollment lasts for 60 days. This means that individuals have a limited window of time, specifically 60 days, to sign up for or modify their health insurance plans.

    Rate this question:

  • 38. 

    For MMA, Enrollees 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 previously (if available). 

    • A.

      • no change

    • B.

      • open enrollment

    • C.

      • temporary loss

    • D.

      • lock-In

    Correct Answer
    C. • temporary loss
    Explanation
    Enrollees whose Medicaid eligibility ends for less than 6 months are in a temporary loss period. This means that their Medicaid coverage is temporarily suspended, but if they regain eligibility within the specified time frame, they will be reinstated back into the plan they had previously. This period allows individuals to maintain continuity of care and ensures that they do not have a gap in their healthcare coverage.

    Rate this question:

  • 39. 

    Under which of the following categories is the enrollee required to be enrolled in managed care? 

    • A.

      • Mandatory

    • B.

      • Voluntary

    • C.

      • Excluded

    Correct Answer
    A. • Mandatory
    Explanation
    Enrollees are required to be enrolled in managed care under the category of "Mandatory". This means that it is compulsory for individuals to participate in managed care programs, and they do not have the option to opt out or choose an alternative healthcare arrangement.

    Rate this question:

  • 40. 

    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

    Correct Answer
    D. • Prescription Medication
    Explanation
    Prescription Medication is not provided by the Long-Term Care program. The program focuses on providing services such as respite care, adult day healthcare, home-delivered meals, and assisted living. Prescription medication is typically covered by health insurance or Medicare Part D, rather than the Long-Term Care program.

    Rate this question:

Back to Top Back to top
Advertisement
×

Wait!
Here's an interesting quiz for you.

We have other quizzes matching your interest.