2018 Fl Smmc Program Overview Quiz

40 Questions | Total Attempts: 169

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2018 Fl Smmc Program Overview 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

  • 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

  • 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.

  • 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

  • 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.

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

      • KidCare Applicants

    • B. 

      • DCF Applicants

    • C. 

      • SSA Applicants

    • D. 

      • WIC Applicants

  • 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.

  • 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

  • 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.

  • 11. 
    Once enrolled, enrollees must see providers that participate with their managed care plan. 
    • A. 

      True

    • B. 

      False

  • 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.

  • 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

  • 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."

  • 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.

  • 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.

  • 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.

  • 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

  • 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

  • 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

  • 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.

  • 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.

  • 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.

  • 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

  • 25. 
    Enrollees will initially have  __________ days to change the plan without a Good Cause Reason. 
    • A. 

      • 180

    • B. 

      • 90

    • C. 

      • 120

    • D. 

      • 30

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