AHM-530 Free Practice Test

- (Topic 1)
In open panel contracting, there are several types of delivery systems. One such delivery system is the faculty practice plan (FPP). One likely result that a health plan will experience by contracting with an FPP is that the health plan will

1. A. be able to select most of the physicians in the FPP
2. B. achieve the highest level of cost effectiveness possible
3. C. experience limited control over utilization
4. D. achieve the most effective case management possible

Correct Answer: C

- (Topic 2)
One true statement about the Medicaid program in the United States is that:

1. A. The federal financial participation (FFP) in a state's Medicaid program ranges from 20% to 40% of the state's total Medicaid costs
2. B. Medicaid regulations mandate specific minimum benefits, under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program, for all Medicaid recipients younger than age 30
3. C. The individual states have responsibility for administering the Medicaid program
4. D. Non-disabled adults and children in low-income families account for the majority of direct Medicaid spending

Correct Answer: C

- (Topic 1)
The Brice Health Plan submitted to Clarity Health Services a letter of intent indicating Brice’s desire to delegate its demand management function to Clarity. One true statement about this letter of intent is that it

1. A. creates a legally binding relationship between Brice and Clarity
2. B. most likely contains a confidentiality clause committing Brice and Clarity to maintain theconfidentiality of documents reviewed and exchanged in the process
3. C. prohibits Clarity from performing similar delegation activities for other health plans
4. D. most likely contains a detailed description of the functions that Brice will delegate to Clarity

Correct Answer: B

- (Topic 2)
Following statements are about accreditation of health plans:

1. A. The National Committee for Quality Assurance (NCQA) serves as the primary accrediting agency for most health maintenance organizations (HMOs).
2. B. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has developed standards that can be used for the accreditation of hospitals, but not for the accreditation of health plan provider networks or health plan plans.
3. C. States are required to adopt the model standards developed by the National Association of Insurance Commissioners (NAIC), an organization of state insurance regulators that develops standards to promote uniformity in insurance regulations.
4. D. Accreditation is an evaluative process in which a health plan undergoes an examination of its operating procedures to determine whether the procedures meet designated criteria as defined by the federal government or by the state governments.

Correct Answer: A

- (Topic 2)
The Pine Health Plan has incorporated pharmacy benefits management into its operations to form a unified benefit. Potential advantages that Pine can receive from this action include:

1. A. the fact that unified benefits improve the quality of patient care and the value of pharmacy services to Pine's plan members
2. B. the fact that control over the formulary and network contracting can give Pine control over patient access to prescription drugs and to pharmacies
3. C. the fact that managing pharmacy benefits in-house gives Pine a better chance to meet customer needs by integrating pharmacy services into the plan's total benefits package
4. D. all of the above

Correct Answer: D