Supervisor And Team Lead Quiz 12/3-4/2014

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Supervisor And Team Lead Quiz 12/3-4/2014 - Quiz



Questions and Answers
  • 1. 

    If an infant is born on November 6, what date will the newborn's plan be effective?

    • A.

      January 1

    • B.

      December 1

    • C.

      October 1

    • D.

      November 1

    Correct Answer
    D. November 1
    Explanation
    The newborn's plan will be effective on November 1. The question states that the infant is born on November 6, so the plan will start on the first day of the same month, which is November 1.

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  • 2. 

    Members being transitioned from First Coast Advantage to Molina will not receive 90 days to 'try out' the plan.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Members being transitioned from First Coast Advantage to Molina will receive 90 days to 'try out' the plan. This means that during this period, they can evaluate the plan and decide if it meets their needs. This allows them to have a trial period before committing to the new plan.

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  • 3. 

    Before the LTC cut-off date, if a LTC auto-assignment has processed and the caller does not want that plan, how should the agent proceed?

    • A.

      The agent should place the request on the discrepancy log.

    • B.

      The agent should confirm the auto-assignment and explain that no change can be made at this time.

    • C.

      The agent should tell the caller to call back after the cut-off date.

    • D.

      The agent should process the change through the wizard.

    Correct Answer
    D. The agent should process the change through the wizard.
    Explanation
    The correct answer is "The agent should process the change through the wizard." This is because if the caller does not want the LTC auto-assignment plan before the cut-off date, the agent should process the change through the wizard to select a different plan that the caller prefers.

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  • 4. 

    Special Condition spans: ‘LTC Non-COMP’ and ‘SMMC COMP Enrolled' are added as a member's special condition based on____________?

    • A.

      LTC or Comprehensive needs.

    • B.

      MMA Eligibility

    • C.

      LTC or Comprehensive enrollments.

    • D.

      LTC Eligibility

    Correct Answer
    C. LTC or Comprehensive enrollments.
    Explanation
    The correct answer is "LTC or Comprehensive enrollments." This means that if a member has a special condition related to long-term care (LTC) or comprehensive needs, they will be added to the "LTC Non-COMP" or "SMMC COMP Enrolled" special condition spans. This indicates that the special condition is based on the member's enrollment in LTC or comprehensive coverage.

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  • 5. 

    Where should you refer LTC recipients who need additional assistance with changing from a PACE plan?

    • A.

      Local Area Office

    • B.

      Elder Helpline

    • C.

      CARES

    • D.

      DCF

    Correct Answer
    B. Elder Helpline
    Explanation
    LTC recipients who need additional assistance with changing from a PACE plan should refer to the Elder Helpline. This helpline is specifically designed to provide support and guidance to elderly individuals, including those who require help with navigating and transitioning between healthcare plans. The Elder Helpline can provide the necessary information and resources to ensure a smooth transition for LTC recipients.

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  • 6. 

    How will PACE enrollees receive their medical services?

    • A.

      Through PACE because PACE covers medical and LTC services.

    • B.

      Through straight medicaid/FFS.

    • C.

      Through a MMA plan.

    • D.

      Through a LTC plan.

    Correct Answer
    A. Through PACE because PACE covers medical and LTC services.
    Explanation
    PACE enrollees will receive their medical services through PACE because PACE (Program of All-Inclusive Care for the Elderly) covers both medical and long-term care (LTC) services. PACE is a comprehensive healthcare program that provides coordinated and integrated care to eligible individuals, including medical care, prescription drugs, social services, and LTC services. Therefore, PACE enrollees can access all their necessary medical services through this program.

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  • 7. 

    Mom calls in on 11/12/14 to enroll her newborn into Humana and assign the child's pediatrician. You see in HealthTrack there is a current enrollment into Humana effective 11/01/2014. How should you proceed? 

    • A.

      Place the request on the Discrepancy Log.

    • B.

      Process a plan change to Humana through the SMMC wizard.

    • C.

      Inform mom to call Humana to assign the pcp.

    Correct Answer
    C. Inform mom to call Humana to assign the pcp.
    Explanation
    Since there is already a current enrollment into Humana effective 11/01/2014, the best course of action would be to inform mom to call Humana to assign the child's pediatrician. This is because the enrollment is already in place, so there is no need to place the request on the Discrepancy Log or process a plan change through the SMMC wizard.

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  • 8. 

    Mother calls to select a plan for the child. How do you proceed?

    • A.

      Process request through the SMMC wizard.

    • B.

      Place the request on the Discrepancy Log.

    • C.

      Inform mom to call back on 12/01/2014.

    • D.

      Refer mom to DCF to confirm eligibility.

    Correct Answer
    A. Process request through the SMMC wizard.
    Explanation
    To proceed with selecting a plan for the child, the correct answer is to process the request through the SMMC wizard. This suggests that there is a specific system or tool called the SMMC wizard that should be used to handle this type of request. By using this wizard, the process can be streamlined and ensure that all necessary steps are followed to select the appropriate plan for the child.

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  • 9. 

    The member below states he does not have HIV/AIDS. He insists that the special medical condition be taken off his case because he does not want to be enrolled into Clear Health Alliance HIV/AIDS Specialty Plan. How do you proceed?

    • A.

      Refer the member to DCF to have the condition removed.

    • B.

      File a Complaint (Special Condition Update).

    • C.

      Place the request on the Discrepancy Log to be removed.

    Correct Answer
    B. File a Complaint (Special Condition Update).
    Explanation
    The correct answer is "File a Complaint (Special Condition Update)." This option is chosen because the member is requesting that the special medical condition be taken off his case. By filing a complaint and updating the special condition, the member's request can be addressed and the necessary changes can be made to his enrollment in the Clear Health Alliance HIV/AIDS Specialty Plan.

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  • 10. 

    The member below calls in before the cut-off date to process a plan change to Staywell. She later calls back after cut-off and states she needs to remain in United. She has an appointment with her specialist in December and this is the only plan her specialist takes. How do you proceed?  

    • A.

      Place the request on the Discrepancy Log.

    • B.

      Process a plan change through the SMMC wizard. Send an email request for an earlier effective date to Marsha and copy Lisa.

    • C.

      Inform the caller that the plan cannot be back dated at this time.

    • D.

      Process the request through the wizard and explain to the member that United will be effective again in January.

    Correct Answer
    B. Process a plan change through the SMMC wizard. Send an email request for an earlier effective date to Marsha and copy Lisa.
    Explanation
    The correct answer is to process a plan change through the SMMC wizard and send an email request for an earlier effective date to Marsha and copy Lisa. This is because the member initially requested a plan change to Staywell but later realized she needs to remain in United due to an upcoming specialist appointment. By processing the plan change through the SMMC wizard, the necessary changes can be made to the member's plan. Additionally, sending an email request for an earlier effective date to Marsha and copying Lisa ensures that the request is properly documented and communicated to the relevant parties.

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  • 11. 

    Caller calls in and states she wants her daughter to remain in her current plan of Molina. How do you proceed?

    • A.

      Convert the pending request to a voluntary choice.

    • B.

      Cancel the pending request.

    • C.

      Place the request on the Discrepancy Log.

    • D.

      Convert the current enrollment to a voluntary choice.

    Correct Answer
    D. Convert the current enrollment to a voluntary choice.
    Explanation
    If the caller wants her daughter to remain in her current plan of Molina, the best course of action would be to convert the current enrollment to a voluntary choice. This means that the daughter will have the option to continue with the Molina plan, rather than being automatically switched to a different plan. This allows the caller to maintain her daughter's desired plan while still giving her the freedom to choose.

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  • 12. 

    Member calls in on November 21, 2014 to process a plan change to Amerigroup. At the end of the call, when provided the effective date, she states she needs Amerigroup to become effective ASAP. She has an appointment in December and this is the only plan her provider accepts. How do you proceed?

    • A.

      Cancel the pending request. Send a email request for an earlier effective date to Marsha and copy Lisa.

    • B.

      Inform the caller that the plan cannot be back dated at this time.

    • C.

      Place the request on the Discrepancy Log.

    Correct Answer
    A. Cancel the pending request. Send a email request for an earlier effective date to Marsha and copy Lisa.
  • 13. 

    CMS Pre-Pending Request cannot be cancelled. 

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    The statement "CMS Pre-Pending Request cannot be cancelled" is false. This means that CMS Pre-Pending Requests can be cancelled.

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  • 14. 

    Indicator: "Recipient Resides in a State Hospital" will appear in what tab in the Span Information? 

    • A.

      Special Conditions

    • B.

      Level of Care

    • C.

      Waiver Program

    • D.

      APD

    Correct Answer
    C. Waiver Program
    Explanation
    The correct answer is "Waiver Program." The indicator "Recipient Resides in a State Hospital" will appear in the Waiver Program tab in the Span Information. This suggests that the recipient's residency in a state hospital is relevant to the waiver program, which may have specific provisions or considerations for individuals in this situation.

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  • 15. 

    Recipients that reside in a state hospital will have which member type?

    • A.

      Excluded

    • B.

      Mandatory

    • C.

      Voluntary

    Correct Answer
    A. Excluded
    Explanation
    Recipients that reside in a state hospital will have the member type "Excluded" because they are not eligible for the benefits provided by the healthcare plan. This could be due to the fact that state hospitals already provide the necessary care and services to these recipients, making them exempt from the coverage offered by the healthcare plan.

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  • 16. 

    The Public Session Tab has been added to which website?

    • A.

      MyFlorida Website

    • B.

      AHCA Website

    • C.

      Plan Websites

    • D.

      SMMC Website

    Correct Answer
    D. SMMC Website
    Explanation
    The correct answer is SMMC Website. This means that the Public Session Tab has been added to the SMMC (Statewide Medicaid Managed Care) website. This tab is likely designed to provide public access to information, documents, or meetings related to the SMMC program.

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  • 17. 

    Public sessions are...

    • A.

      Sessions where Choice Counselors are available to meet with members on a more personal basis; to choose the best plan for them.

    • B.

      Sessions where Choice Counselors are available to meet with members for help with enrolling and general questions.

    • C.

      Sessions where Choice Counselors are available to meet with anyone to sign them up for Medicaid.

    • D.

      Sessions where AHCA is available to meet with members about the SMMC program.

    Correct Answer
    B. Sessions where Choice Counselors are available to meet with members for help with enrolling and general questions.
    Explanation
    Public sessions are sessions where Choice Counselors are available to meet with members for help with enrolling and general questions. These sessions provide an opportunity for members to receive personalized assistance in selecting the best plan for their needs and to get answers to any questions they may have about the enrollment process or the program in general.

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  • 18. 

    Where would you log a MediKids discrepancy?

    • A.

      MediKids Form

    • B.

      SMMC Discrepancy Log

    • C.

      SMMC Downtime Form

    • D.

      MediKids DAR

    Correct Answer
    A. MediKids Form
    Explanation
    A MediKids discrepancy would be logged in the MediKids Form. This form is specifically designed to record any discrepancies or inconsistencies found in the MediKids system. By logging the discrepancy in the MediKids Form, it ensures that the issue is properly documented and can be addressed and resolved by the appropriate personnel.

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  • 19. 

    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 parent's response indicates that the child has difficulty paying attention in school and may need therapy according to the teacher. Even though the parent states that there are no medical needs, it is important to address the potential need for therapy and inform the caller that the child may qualify for CMS (Centers for Medicare and Medicaid Services). The correct answer advises the caller to proceed with asking the CMS screening questions to further assess the situation and determine eligibility for CMS services.

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  • 20. 

    Children's Medical Services (CMS) is for children under the age of 21 who have special medical, behavioral, or other health care needs that are expected to last longer than 12 months.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Children's Medical Services (CMS) is a program designed to provide medical, behavioral, and other health care services to children under the age of 21 who have long-term special medical needs. These needs are expected to last for more than 12 months. Therefore, the statement that CMS is for children under 21 with long-term medical, behavioral, or health care needs is true.

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  • 21. 

    Since the implementation of SMMC, siblings are no longer eligible to enroll based on another child's CMS enrollment. Any siblings enrolled under CMS...

    • A.

      Must provide proof that they are related to the recipient in CMS.

    • B.

      Must live in the same house as the recipient in CMS.

    • C.

      Must have an active CMS span in order to remain in CMS.

    • D.

      Must have a sibling CMS exemption in order to remain in CMS.

    Correct Answer
    C. Must have an active CMS span in order to remain in CMS.
    Explanation
    The correct answer states that siblings must have an active CMS span in order to remain in CMS. This means that siblings must have an active enrollment period or coverage under CMS to continue being eligible for enrollment. The other options provided do not accurately reflect the requirement for siblings to remain in CMS.

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  • 22. 

    When will the 90 day trial period start for Med Pending enrollments?

    • A.

      90 days will start as soon as the plan starts.

    • B.

      90 days will start on the first month eligibility has been received.

    • C.

      LTC recipients do not get 90 days to try out the plan.

    • D.

      90 days will start after open enrolllment.

    Correct Answer
    B. 90 days will start on the first month eligibility has been received.
    Explanation
    The correct answer is "90 days will start on the first month eligibility has been received." This means that once a person becomes eligible for the plan, their 90-day trial period will begin in the first month of their eligibility. This allows them to try out the plan and decide if it meets their needs within that timeframe.

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  • 23. 

    The LTC plan can limit services for recipients that are receiving services without eligibility.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    The LTC plan cannot limit services for recipients who are receiving services without eligibility. This means that even if a recipient is not eligible for the services they are receiving, the LTC plan cannot restrict or limit those services. Therefore, the statement is false.

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  • 24. 

    What indicator below could have an impact on the plan effective date?

    • A.

      None. The recipient is Mandatory and has full coverage Medicaid until 12/31/14.

    • B.

      The recipient has CHIP Medicaid and the plan will automatically start on 8/1/14.

    • C.

      The recipient has CHIP. They must have active Medicaid in FMMIS for the plan to be effective on 8/1/14.

    • D.

      This is a HealthTrack error because the eligibility is not in FMMIS. Place on the discrepancy log.

    Correct Answer
    C. The recipient has CHIP. They must have active Medicaid in FMMIS for the plan to be effective on 8/1/14.
    Explanation
    The plan effective date could be impacted by the recipient's Medicaid status in FMMIS. In order for the plan to be effective on 8/1/14, the recipient must have active Medicaid in FMMIS. If their Medicaid status is not active in FMMIS, the plan may not be effective on the desired date.

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  • 25. 

    What should you do if the HIV/AIDS special condition is not listed in the system? 

    • A.

      Tell the caller their doctor must update their medical record and report it to AHCA.

    • B.

      Tell the caller to fax us documentation of the special condition, so the case can be updated.

    • C.

      Tell the caller they must report their special condition to the Center's for Disease Control and the Department of Health.

    • D.

      Tell the caller the SNU Nurse will call them to get more information on their special condition and set up a home visit.

    Correct Answer
    B. Tell the caller to fax us documentation of the special condition, so the case can be updated.
    Explanation
    If the HIV/AIDS special condition is not listed in the system, the caller should be instructed to fax documentation of the special condition. This is necessary so that the case can be updated with the correct information.

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  • 26. 

    The caller wants to enroll and says they have many special conditions such as high blood pressure, glaucoma, high cholesterol, back problems and migraines. How should you proceed?

    • A.

      Create a SNU Task because this recipient has too many medical issues. The SNU Nurse will complete the enrollment.

    • B.

      Place on the specialty plan log, so all the special conditions can be updated in HealthTrack and FMMIS. This will allow the caller to enroll into a specialty plan.

    • C.

      Request an exemption for this caller since they have so many medical issues. They need to be on straight Medicaid.

    • D.

      Document the special conditions in HealthTrack and complete the enrollment. The caller does not qualify for any specialty plans at this time.

    Correct Answer
    D. Document the special conditions in HealthTrack and complete the enrollment. The caller does not qualify for any specialty plans at this time.
    Explanation
    The correct answer is to document the special conditions in HealthTrack and complete the enrollment. The caller does not qualify for any specialty plans at this time. This option ensures that the caller's medical issues are properly recorded and taken into consideration during the enrollment process. It also acknowledges that the caller does not meet the criteria for any specialty plans, indicating that they may be better suited for a different type of coverage.

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  • 27. 

    Transfer recipients with questions about Molina benefits, providers, or continuity of care, after December 1st, should be directed to call _________?

    • A.

      Molina

    • B.

      DCF

    • C.

      The area office

    • D.

      First Coast Advantage

    Correct Answer
    A. Molina
    Explanation
    Transfer recipients with questions about Molina benefits, providers, or continuity of care, after December 1st, should be directed to call Molina. This means that if individuals have any queries or concerns regarding their Molina benefits, healthcare providers, or the continuation of their healthcare services after December 1st, they should contact Molina directly. Molina is the appropriate point of contact for addressing these specific issues.

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  • 28. 

    If an infant's mom does not want the plan the newborn is being enrolled into,___________.

    • A.

      Process the plan change request through the wizard.

    • B.

      Place the request on a discrepancy log.

    • C.

      Inform mom the plan cannot be changed.

    • D.

      Inform mom she has to change her plan first.

    Correct Answer
    A. Process the plan change request through the wizard.
    Explanation
    If an infant's mom does not want the plan the newborn is being enrolled into, the correct action would be to process the plan change request through the wizard. This means that the mom can request a change in the plan for the newborn by following the necessary steps and procedures provided in the wizard. This allows for a smooth and efficient process of changing the plan to one that the mom prefers for her newborn.

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  • 29. 

    In HealthTrack, the member's medicaid eligibility and current plan are ending on 11/30/2014. In FMMIS, the member will have a new ACWM code effective 12/01/2014. The member calls in after cut-off and wants to remain enrolled in current plan for 12/01/2014. How do you proceed?

    • A.

      Place the request on the Discrepancy Log.

    • B.

      Process the request through the SMMC wizard. Contact Marsha immediately to process an early effective date.

    • C.

      Explain reinstatement process to member.

    • D.

      Process request through SMMC wizard for a 01/01/2014 effective date.

    Correct Answer
    B. Process the request through the SMMC wizard. Contact Marsha immediately to process an early effective date.
    Explanation
    The member's current plan is ending on 11/30/2014, and they want to remain enrolled in the current plan for 12/01/2014. To accommodate this request, the appropriate action would be to process the request through the SMMC wizard and contact Marsha immediately to process an early effective date. This would ensure that the member can continue with their current plan for the desired date.

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  • 30. 

    What GC should be used for recipients that were enrolled with First Coast Advantage, and do not want to be enrolled with Molina? 

    • A.

      GC11

    • B.

      GC17

    • C.

      GC1610

    • D.

      GC09

    Correct Answer
    C. GC1610
    Explanation
    Recipients who were enrolled with First Coast Advantage and do not want to be enrolled with Molina should use GC1610. This GC code specifically addresses the situation where recipients want to opt out of Molina enrollment.

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  • 31. 

    A caller calls in to obtain the number to their Local Area Office. How do you proceed?

    • A.

      For this case specific call: access the caller's case, go through verification, provide the number to the area office, and then notate the case.

    • B.

      For this general information call: ask the caller to verify the area they live in and provide the number to the area office.

    • C.

      For this general information call: access the caller's case, provide the number to the AHCA Medicaid Helpline, and notate the case.

    • D.

      For this case specific call: access the caller's case, advise the caller on what region they live in, and provide them with the number to the area office.

    Correct Answer
    C. For this general information call: access the caller's case, provide the number to the AHCA Medicaid Helpline, and notate the case.
  • 32. 

    A caller calls in to obtain their Open Enrollment Dates. How do you proceed?

    • A.

      For this case specific call: access the caller's case, advise the caller of their OE Dates, and then notate the case.

    • B.

      For this general information call: ask the caller the start date of their plan and provide them with the OE Dates from the Effective Date Chart.

    • C.

      For this case specific call: access the caller's case, go through verification, provide the OE Dates, and then notate the case.

    • D.

      For this general information call: access the caller's case, and advise the caller that you cannot provide OE dates over the phone; they will receive a notice in the mail.

    Correct Answer
    C. For this case specific call: access the caller's case, go through verification, provide the OE Dates, and then notate the case.
    Explanation
    The correct answer is to access the caller's case, go through verification, provide the OE Dates, and then notate the case. This is because for a case specific call, the agent needs to verify the caller's information and access their case to provide accurate and personalized Open Enrollment Dates. After providing the dates, it is important to notate the case for future reference and documentation purposes.

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  • 33. 

    Where do you refer recipients with questions about the level of care on file?

    • A.

      AHCA

    • B.

      LTC Helpline

    • C.

      Elder Helpline

    • D.

      DCF

    Correct Answer
    C. Elder Helpline
    Explanation
    Recipients with questions about the level of care on file should be referred to the Elder Helpline. This helpline is likely to have the necessary information and resources to assist individuals with their inquiries regarding the level of care. The other options, AHCA, LTC Helpline, and DCF, may not be specifically dedicated to addressing questions about the level of care on file, making them less suitable choices for referrals in this context.

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  • 34. 

    If a member has active Medicaid and MediKids, which coverage dominates?

    • A.

      Neither

    • B.

      FFS

    • C.

      MediKids

    • D.

      Medicaid

    Correct Answer
    D. Medicaid
    Explanation
    If a member has active Medicaid and MediKids, Medicaid coverage dominates. Medicaid is a federal and state program that provides health coverage for low-income individuals and families, while MediKids is a Florida-specific program that provides health coverage for children. Since Medicaid is a broader program that covers a wider range of individuals, it takes precedence over MediKids in terms of coverage. Therefore, if a member has both active Medicaid and MediKids, Medicaid coverage will be the dominant one.

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  • 35. 

    Mandatory children requesting initial enrollment into CMS...

    • A.

      Have to call CMS to process the plan change.

    • B.

      Have to wait until Open Enrollment to change the plan.

    • C.

      Have to select a 'back-up' plan while waiting for approval from CMS.

    • D.

      Do not have to select a 'back-up' plan while waiting for approval from CMS.

    Correct Answer
    C. Have to select a 'back-up' plan while waiting for approval from CMS.
    Explanation
    Mandatory children requesting initial enrollment into CMS have to select a 'back-up' plan while waiting for approval from CMS. This means that they need to choose an alternative plan in case their initial enrollment request is not approved. This ensures that they have coverage while waiting for the approval process to be completed.

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  • 36. 

    Why is the recipient listed below Excluded from enrolling into a LTC plan?

    • A.

      Recipient is receiving Medicaid from the Social Security Administration.

    • B.

      Recipient has ADP: IC meaning they are currently incarcerated.

    • C.

      Medicaid ended on 5/1/2010.

    • D.

      Recipient is currently living in an Intermediate Care Facility for Persons with Developmental Disabilities.

    Correct Answer
    D. Recipient is currently living in an Intermediate Care Facility for Persons with Developmental Disabilities.
    Explanation
    The recipient is excluded from enrolling into a LTC (Long-Term Care) plan because they are currently living in an Intermediate Care Facility for Persons with Developmental Disabilities. This indicates that they are already receiving specialized care and support for their developmental disabilities, so enrolling them into a separate LTC plan would not be necessary or appropriate.

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  • 37. 

    What is the "T" shown for the recipient's LTC coverage mean ?

    • A.

      The recipient's LTC coverage has been terminated and they are no longer receiving services.

    • B.

      The recipient is experiencing a temporary loss and must pay for services until coverage is reinstated.

    • C.

      The recipient is experiencing a temporary loss and will continue to receive services at no charge for 60 days.

    • D.

      The recipient is currently not eligible to be enrolled into a LTC plan.

    Correct Answer
    C. The recipient is experiencing a temporary loss and will continue to receive services at no charge for 60 days.
    Explanation
    The "T" shown for the recipient's LTC coverage means that they are experiencing a temporary loss and will continue to receive services at no charge for 60 days. This indicates that there may be a temporary issue with their coverage, but they will still be able to receive the necessary services without any cost for a specific period of time.

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  • 38. 

    For LTC plans, enrollees that have a "temporary loss" will

    • A.

      Be responsible to pay for services while experiencing a temporary loss of Medicaid.

    • B.

      Be disenrolled from their Long Term Care plan.

    • C.

      Continue recieving services from the LTC plan for up to 60 days.

    • D.

      None of the above

    Correct Answer
    C. Continue recieving services from the LTC plan for up to 60 days.
    Explanation
    Enrollees in LTC plans who experience a "temporary loss" will continue receiving services from the LTC plan for up to 60 days. This means that even if they temporarily lose their Medicaid coverage, they will still be able to access the services provided by the LTC plan for a limited period of time. This allows them to continue receiving the necessary care and support during the temporary loss of Medicaid.

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  • 39. 

    The caller says:  "I already have a Medicare Advantage Plan; I don't need another health plan."  How should you proceed?

    • A.

      Explain to the caller that they will have two health plans; the Medicare plan is for long term care services and the Medicaid plan is for medical services.

    • B.

      Place on the Medicare Advantage Log. Anyone that has any type of Medicare is Voluntary for enrollment.

    • C.

      Explain to the caller that they are Mandatory for enrollment and need to choose a Medicaid plan.

    • D.

      Place on the Medicare Advantage Plan Log. AHCA will verify if they are in a Medicare Advantage Plan and will change the status to Excluded.

    Correct Answer
    D. Place on the Medicare Advantage Plan Log. AHCA will verify if they are in a Medicare Advantage Plan and will change the status to Excluded.
  • 40. 

    Scenario:  A recipient calls on Aug 15 to complete a LTC enrollment. LTC eligibility started on 7/1/14.  The plan effective date provided by HealthTrack is October 1.  How should you proceed?

    • A.

      Provide the caller the effective date and end the call.

    • B.

      Refer to DOEA for an earlier effective date.

    • C.

      Tell the caller they can receive LTC services through the MMA plan.

    • D.

      Research the case and place on the discrepancy log because it should have a 9/1/14, effective date.

    Correct Answer
    D. Research the case and place on the discrepancy log because it should have a 9/1/14, effective date.
    Explanation
    The correct answer is to research the case and place it on the discrepancy log because the effective date provided by HealthTrack is October 1, which is inconsistent with the LTC eligibility starting on 7/1/14. This suggests that there may be an error or discrepancy in the information, and it should be investigated further. Placing it on the discrepancy log will ensure that it is properly documented and addressed.

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