Dec 26-refresher Activity 2
.webp "Dec 26-refresher Activity 2 - Quiz")
- 1.
Why did the member receive the 'LTC Welcome-Non-Fully Eligible' letter?
- A.
The member received the letter because a Medicaid Application was submitted. The letter informs them to wait for approval from DCF before calling to enroll into a LTC plan.
- B.
The letter informs the member they were not approved for LTC.
- C.
The letter includes the member's LTC auto-assignment and start date.
- D.
The member has submitted a Medicaid Application and has established a Level of Care; therefore the member is Application Pending and has the ability to enroll into an LTC plan.
Correct Answer
D. The member has submitted a Medicaid Application and has established a Level of Care; therefore the member is Application Pending and has the ability to enroll into an LTC plan.Explanation
The member received the 'LTC Welcome-Non-Fully Eligible' letter because they have submitted a Medicaid Application and have established a Level of Care. This means that the member is Application Pending, and as a result, they have the ability to enroll into an LTC plan. The letter serves as an acknowledgement of their application and informs them that they can proceed with enrolling into an LTC plan while waiting for approval from DCF.Rate this question:
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- 2.
What type of request is this?
- A.
A Good Cause plan change request to CMS.
- B.
A 90 day plan change request to CMS.
- C.
A 60 day plan change request to CMS.
Correct Answer
A. A Good Cause plan change request to CMS.Explanation
This request is a Good Cause plan change request to CMS. The term "Good Cause" suggests that there is a valid reason or justification for the plan change. The request is being made to CMS, which indicates that it is related to some sort of healthcare or insurance plan.Rate this question:
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- 3.
What type of LTC enrollment request is this?
- A.
Auto-Assignment
- B.
Pending Choice
- C.
Medicaid Pending
- D.
Plan Change
Correct Answer
C. Medicaid PendingExplanation
This LTC enrollment request is categorized as "Medicaid Pending" because it indicates that the individual's Medicaid application is still being processed and their eligibility for long-term care services is pending.Rate this question:
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- 4.
This complaint is in what status?
- A.
Resolved
- B.
Open
- C.
AHCA Review
Correct Answer
B. OpenExplanation
The complaint is in the "Open" status.Rate this question:
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- 5.
When did this member's current Medicaid begin?
- A.
08/01/2008
- B.
06/01/2008
- C.
01/01/2008
- D.
02/01/2008
Correct Answer
B. 06/01/2008Explanation
The member's current Medicaid began on 06/01/2008.Rate this question:
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- 6.
Does this recipient have Medicare coverage?
- A.
Yes
- B.
No
Correct Answer
A. YesExplanation
The recipient has Medicare coverage because the answer provided is "Yes". This indicates that the recipient is covered by Medicare, a federal health insurance program in the United States for individuals who are 65 years old or older, or have certain disabilities.Rate this question:
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- 7.
What MMA plan is this member currently enrolled in?
- A.
SMMC Long-Term Care (LTCC) effective 09/01/2014
- B.
SMMC MMA Capitated effective 09/01/2014
- C.
Medicaid HMO effective 12/01/2012
- D.
SMMC MMA Capitated effective 11/01/2014
Correct Answer
D. SMMC MMA Capitated effective 11/01/2014Explanation
The member is currently enrolled in the SMMC MMA Capitated plan effective 11/01/2014. This can be determined by looking at the dates mentioned for each plan. The SMMC Long-Term Care (LTCC) plan was effective from 09/01/2014, the Medicaid HMO plan was effective from 12/01/2012, and the SMMC MMA Capitated plan was effective from 09/01/2014 and again from 11/01/2014. Therefore, the most recent plan that the member is enrolled in is the SMMC MMA Capitated plan effective 11/01/2014.Rate this question:
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- 8.
When was the active special condition last updated?
- A.
10/01/2006
- B.
06/30/2011
- C.
02/28/2011
- D.
04/30/2014
Correct Answer
D. 04/30/2014Explanation
The active special condition was last updated on 04/30/2014.Rate this question:
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- 9.
What ACWM does this recipient have?
- A.
MA R
- B.
MI S
- C.
MM P
- D.
MS
Correct Answer
D. MSExplanation
The recipient has the ACWM of MS.Rate this question:
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- 10.
Caller is locked in and says: "My doctor said he is no longer taking my plan starting next month. I really like this doctor because he takes his time and explains everything. I want to change the plan so I can keep seeing him." Which GC would apply?
- A.
GC11
- B.
GC4
- C.
GC9
- D.
GC1
Correct Answer
D. GC1Explanation
GC1 would apply in this situation because the caller wants to change their plan in order to continue seeing their preferred doctor. GC1 states that if a caller wants to change their plan in order to continue seeing a specific provider, they should be transferred to the appropriate department to discuss plan options.Rate this question:
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- 11.
A member has called several times and states their doctor will stop taking their current plan starting next month. You look in HealthTrack and the PCP is still showing with the curent plan, so the GC1(Provider No Longer with Plan) is denied. You explain this to the caller and they state they have a letter from the doctor's office that states the PCP is no longer taking the plan. What should you do next?
- A.
Tell the caller to fax the letter so it can be sent to AHCA for verification.
- B.
Tell the caller they have to wait until open enrollment to change.
- C.
Refer the caller to the health plan to request a new doctor.
- D.
Tell the caller to get an out of network authorization.
Correct Answer
A. Tell the caller to fax the letter so it can be sent to AHCA for verification.Explanation
Based on the given scenario, the caller claims to have a letter from the doctor's office stating that the PCP is no longer accepting the plan. To verify this information, the best course of action would be to ask the caller to fax the letter so that it can be sent to AHCA (Agency for Health Care Administration) for verification. This will allow the AHCA to confirm the validity of the letter and make the necessary adjustments to the plan if required.Rate this question:
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- 12.
Caller is locked in and says: "The company that delivers my meals told me they will stop taking my plan next month. I really like them because they are always on time and they make good food. Can I change my plan to a plan they will take?" Which Good Cause would you use?
- A.
GC4
- B.
GC1
- C.
GC9
- D.
GC17
Correct Answer
B. GC1Explanation
The correct answer is GC1. GC1, also known as "Protecting the rights and interests of consumers," would be the most appropriate Good Cause to use in this situation. The caller is expressing concern about their current meal delivery company no longer accepting their plan. By selecting GC1, the agent would be demonstrating a commitment to ensuring that the customer's rights and interests are protected. This would involve exploring alternative plans that the company does accept, in order to provide the caller with a satisfactory solution.Rate this question:
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- 13.
What is the grievance?
- A.
The grievance is a formal complaint filed by the recipient with the plan concerning issues.
- B.
The grievance is a formal complaint made by the plan against the recipient for complaining.
- C.
The grievance is when the recipient calls AHS and complains about the plan.
- D.
The grievance is a court setting in which the member, health plan, and AHCA meet.
Correct Answer
A. The grievance is a formal complaint filed by the recipient with the plan concerning issues.Explanation
The correct answer is the first option: "The grievance is a formal complaint filed by the recipient with the plan concerning issues." This option accurately defines what a grievance is, which is a formal complaint made by the recipient to the plan regarding any issues or concerns they may have.Rate this question:
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- 14.
If a PACE enrollee no longer needs LTC services...
- A.
Then the member must call PACE.
- B.
Then the member must complete another CARES assessment.
- C.
Then the member must call DOEA.
- D.
Then a disenrollment request can be completed.
Correct Answer
D. Then a disenrollment request can be completed.Explanation
If a PACE enrollee no longer needs LTC services, they can complete a disenrollment request. This means that they can formally request to be removed from the PACE program since they no longer require long-term care services.Rate this question:
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- 15.
What are the enrollment options for the recipient below?
- A.
Member can enroll in any plan except PACE.
- B.
Member can only enroll in an HMO.
- C.
Member can enroll in any plan including PACE.
- D.
Member can only enroll in PACE.
Correct Answer
D. Member can only enroll in PACE.Explanation
The correct answer is "Member can only enroll in PACE." This means that the recipient is only eligible to enroll in the PACE plan and cannot choose any other plan options.Rate this question:
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- 16.
This member is Excluded under MMA because...
- A.
The member has a PACE exemption.
- B.
The member is receiving medical services through a private insurance.
- C.
PACE provides medical services as well as LTC services.
Correct Answer
C. PACE provides medical services as well as LTC services.Explanation
This answer is correct because PACE (Program of All-Inclusive Care for the Elderly) is a program that provides comprehensive medical and long-term care services for eligible individuals. It covers both medical services and long-term care services, making it an appropriate option for individuals who need both types of care. The fact that PACE provides both medical and LTC services makes it a valid reason for a member to be excluded under MMA.Rate this question:
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- 17.
What enrollment options does this member have?
- A.
This member can change to a LTC plan.
- B.
This member can disenroll and use FFS.
- C.
This member can request to disenroll from the LTC program or may remain in their current plan.
- D.
This member must stay enrolled into PACE for a year.
Correct Answer
C. This member can request to disenroll from the LTC program or may remain in their current plan.Explanation
This member has the option to either request to disenroll from the LTC program or to remain in their current plan.Rate this question:
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- 18.
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 1Explanation
The newborn's plan will be effective on November 1 because the question states that the infant is born on November 6. Therefore, the plan will start on the first day of the same month, which is November 1.Rate this question:
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- 19.
If an infant's mom does not want the plan the newborn is being enrolled into and wants to change to another plan, how should you proceed?
- 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
To proceed with changing the plan for the newborn, the appropriate course of action is to process the plan change request through the wizard. This suggests that there is a specific system or tool in place that allows for the efficient and accurate processing of plan change requests. By utilizing the wizard, the necessary steps and information can be provided to facilitate the change in plan for the infant, ensuring a smooth transition to the desired plan.Rate this question:
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- 20.
When is the cut-off date for LTC?
- A.
The cut-off date is the 2nd to the last day of the month.
- B.
The cut-off is the last day of the month
- C.
The cut-off is the Thursday before the 2nd to the last Saturday of the month.
- D.
The cut-off is immediately after the green check mark appears in HealthTrack.
Correct Answer
B. The cut-off is the last day of the monthExplanation
The explanation for the given correct answer is that the cut-off date for LTC is the last day of the month. This means that any transactions or requests related to LTC must be completed or submitted by the end of the month in order to be considered for processing.Rate this question:
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- 21.
If a caller is not eligible for Freedom Health (Specialty Plan) but feels they should be eligible to enroll, what should you do?
- A.
Advise the caller to contact DCF.
- B.
Advise the caller to contact the AHCA Medicaid Helpline.
- C.
Refer the caller to Freedom Health.
- D.
Place this on the discrepancy log.
Correct Answer
C. Refer the caller to Freedom Health.Explanation
If a caller is not eligible for Freedom Health (Specialty Plan) but feels they should be eligible to enroll, the appropriate action would be to refer the caller to Freedom Health. This means directing the caller to contact Freedom Health directly for further assistance or clarification regarding their eligibility.Rate this question:
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- 22.
If the recipient does not want the specialty plan they are being Auto-Assigned to and the recipient has a current, active MMA Auto-Assignment, you should:
- A.
Use the 'convert to voluntary choice' feature to allow the recipient to voluntarily select their current plan.
- B.
Advise the caller, that they need to be in the specialty plan because they qualify for it with the special condition on their file.
- C.
Place the request on the specialty plan discrepancy log.
- D.
Click on the gray arrow for the specialty plan Auto-Assignment and try to cancel the request.
Correct Answer
A. Use the 'convert to voluntary choice' feature to allow the recipient to voluntarily select their current plan.Explanation
If the recipient does not want the specialty plan they are being Auto-Assigned to and they have a current, active MMA Auto-Assignment, the best course of action is to use the 'convert to voluntary choice' feature. This will give the recipient the option to choose their current plan voluntarily. This ensures that the recipient has control over their plan selection and can choose the plan that best suits their needs.Rate this question:
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- 23.
The caller states: "The doctor I had under my old plan does not take this new MMA plan, he only takes FFS. I called the plan and they said I can still see this doctor for my next 2 appointments because they were already scheduled. Even though the plan is going to cover these appointments, the doctor will not see me because they only take FFS." How should you proceed?
- A.
Place on the discrepancy log for an Exemption to be requested from AHCA, so the recipient can see the doctor under FFS.
- B.
Disenroll the recipient so they can use FFS to see their doctor because they have an established active relationship.
- C.
Tell the caller ALL providers must participate in MMA and refer to the Medicaid Area Office.
- D.
Explain continuity of care and file a Complaint against the provider.
Correct Answer
D. Explain continuity of care and file a Complaint against the provider. -
- 24.
Caller states: "I went to the pharmacy to pick up my seizure medication and they told me I had to pay out of pocket because my new plan would not cover it! It's too expensive, I can't pay for it! That's why I'm on Medicaid! I need my medicine!" How should you proceed?
- A.
Explain continuity of care and tell the caller to call the new plan and provide them with prescription information.
- B.
Tell the caller they will have to pay out of pocket for prescription refills and refer to the Medicaid Area Office.
- C.
File a complaint against the new MMA plan for not covering prescriptions.
- D.
Tell the caller they can use Enhanced Benefits credits to pay for the prescriptions.
Correct Answer
A. Explain continuity of care and tell the caller to call the new plan and provide them with prescription information.Explanation
Continuity of care is important for individuals with chronic conditions like seizures. By explaining continuity of care to the caller, they can understand the significance of maintaining their medication regimen. Advising the caller to contact their new plan and provide prescription information allows them to address the coverage issue directly. This approach ensures that the caller receives the necessary medication and avoids any potential disruptions in their treatment.Rate this question:
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- 25.
"I need help with my medications. My hands shake so much that I can't even take the pills out of the bottle. I have to give myself my Diabetes shot in my stomach and I can't even fill the syringe with the medicine." Which covered service is the recipient referring to?
- A.
Medical Equipment and Supplies
- B.
Personal Care
- C.
Respite Care
- D.
Medication Administration
Correct Answer
D. Medication AdministrationExplanation
The recipient is referring to the service of Medication Administration. They are unable to take their pills out of the bottle due to their shaking hands and are also unable to fill the syringe with medicine for their Diabetes shot. Medication Administration would involve someone assisting them with taking their medications and administering the Diabetes shot.Rate this question:
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- 26.
"I just moved in with my grandmother to take care of her. She has dementia and she has lots of medical complications. I am not really familiar with her illness or how to help her. I need help so I can help her." Which covered service is the recipient referring to?
- A.
Personal Care
- B.
Medication Administration
- C.
Caregiver Training
- D.
Behavioral Management
Correct Answer
C. Caregiver TrainingExplanation
The recipient is referring to Caregiver Training. They have recently moved in with their grandmother who has dementia and multiple medical complications. They express a lack of familiarity with her illness and how to help her, indicating a need for training in order to provide the necessary care and support.Rate this question:
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- 27.
"I don't have anyone that can help me cook, so I need to have my food brought to my house." Which covered service is the recipient referring to?
- A.
Personal Care
- B.
Home Delivered Meals
- C.
Homemaker Services
- D.
Nutritional Assessment/Risk Reduction Services
Correct Answer
B. Home Delivered MealsExplanation
The recipient is referring to Home Delivered Meals as the covered service. They mention that they don't have anyone to help them cook, so they need to have their food brought to their house. Home Delivered Meals specifically caters to individuals who are unable to prepare their own meals and provides them with nutritious meals that are delivered to their homes.Rate this question:
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- 28.
"My mother doesn't want to move in with me; she feels like she can still do it all at 90 years old. I'm afraid she will have an accident and won't be able to get help. Last time she fell in the back yard and broke her hip. She was there for hours before the neighbor saw her. She needs that help bracelet she used to wear." Which covered service is the recipient referring to?
- A.
Personal Emergency Response Systems
- B.
Respite Care
- C.
Medication Management
- D.
Personal Care
Correct Answer
A. Personal Emergency Response SystemsExplanation
The recipient is referring to Personal Emergency Response Systems. This is evident from the statement that the mother needs the help bracelet she used to wear, indicating that she requires a device that can provide immediate assistance in case of accidents or emergencies.Rate this question:
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- 29.
Comprehensive Care Plans are plans that will provide services to recipients that are eligible for MMA and LTC.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Comprehensive Care Plans are indeed plans that provide services to recipients who are eligible for both the Medicare-Medicaid Alignment Initiative (MMA) and long-term care (LTC). These plans aim to coordinate and integrate care for individuals who qualify for both programs, ensuring they receive the necessary medical and long-term care services. Therefore, the statement is true.Rate this question:
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- 30.
After enrolling into an LTC plan, additional assistance and coordination of care will be provided through a ______________
- A.
DCF caseworker; who will meet with enrollees to perform an assessment, develope 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 an LTC plan, a care coordinator/case manager will be assigned to the enrollees. This care coordinator/case manager will have the responsibility of meeting with the enrollees to perform an assessment of their needs, developing a personalized plan of care, and assisting the enrollee in obtaining the appropriate care. The care coordinator/case manager will serve as a point of contact for the enrollees, providing them with additional assistance and coordinating their care to ensure they receive the necessary services and support.Rate this question:
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- 31.
Pending Choice is when
- A.
The managed care plan cannot deny or delay services based on their Medicaid eligibilty status.
- B.
The recipient can choose a plan but will not start services until Medicaid has been approved.
- C.
Services will start prior to Medicaid being approved.
- D.
None of the Above
Correct Answer
B. The recipient can choose a plan but will not start services until Medicaid has been approved.Explanation
Pending Choice refers to a situation where the recipient of a managed care plan can select a plan but will not receive any services until their Medicaid eligibility has been approved. This means that even though the recipient has chosen a plan, they cannot start receiving services until their Medicaid eligibility is confirmed. This option is different from the other choices provided, as it specifically mentions the recipient's ability to choose a plan and the requirement for Medicaid approval before services can begin.Rate this question:
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- 32.
Recipients that do not want to receive services before eligibility is granted may
- A.
Choose a pending plan choice that will be saved in the system until eligibility is received.
- B.
Have more time to decide on a service provider they are interested in.
- C.
Call back to choose their care plan once eligibility is received.
- D.
All of the above.
Correct Answer
D. All of the above.Explanation
The correct answer is "All of the above." This means that recipients who do not want to receive services before eligibility is granted have the option to choose a pending plan choice, which will be saved in the system until eligibility is received. They also have more time to decide on a service provider they are interested in, and they can call back to choose their care plan once eligibility is received.Rate this question:
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- 33.
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 Med Pending enrollments, their 90-day trial period will begin in the first month of their eligibility.Rate this question:
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- 34.
If a caller calls in and states they are an Emancipated Minor and is listed as their own payee, continue with the call.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
If a caller claims to be an Emancipated Minor and is listed as their own payee, the correct course of action is to not continue with the call. Emancipated minors are individuals who have been legally granted independence from their parents or guardians. However, even if someone is an emancipated minor, it does not necessarily mean they have the authority to act as their own payee. Therefore, it is important to verify their claim and ensure that they have the necessary legal documentation before proceeding with any further actions.Rate this question:
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- 35.
For the MMA program, a "temporary loss" is defined as 180 days or less?
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
A "temporary loss" for the MMA program is defined as a period of 180 days or less. This means that if an individual experiences a loss of income or employment for a period of 180 days or less, they would be considered to have a temporary loss and may be eligible for certain benefits or assistance under the MMA program.Rate this question:
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- 36.
Which plans does Dr. Rufus Joseph accept?
- A.
Clear Health Alliance
- B.
Magellan Complete Care
- C.
Better Health
- D.
All of the above
Correct Answer
D. All of the aboveExplanation
Dr. Rufus Joseph accepts all of the mentioned plans, which include Clear Health Alliance, Magellan Complete Care, and Better Health. This means that patients with any of these plans can seek medical treatment from Dr. Rufus Joseph.Rate this question:
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- 37.
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.
Correct Answer
C. A plan that will serve Medicaid recipients who have special needs based on age, medical conditions, or diagnosis.Explanation
A MMA Specialty Plan is a type of plan that is specifically designed to serve Medicaid recipients who have special needs based on factors such as age, medical conditions, or diagnosis. This plan aims to provide specialized care and support to individuals who require additional assistance and resources due to their unique circumstances.Rate this question:
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- 38.
Florida's Managed Medical Assistance program will provide Medicaid services such as...?
- A.
Doctors and specialist visits, prescription medication, hospital services, and transportation.
- B.
Nursing home services, inpatient/outpatient services, personal care, and transportation.
- C.
Doctors and specialist visits, homemaker services, dental services, and transportation.
- D.
Nursing facility, Assisted living, respite care, and transportation.
Correct Answer
A. Doctors and specialist visits, prescription medication, hospital services, and transportation.Explanation
The correct answer is Doctors and specialist visits, prescription medication, hospital services, and transportation. This is because Florida's Managed Medical Assistance program aims to provide Medicaid services that include access to doctors and specialists, prescription medications, hospital services, and transportation for eligible individuals. It does not mention nursing home services, personal care, homemaker services, dental services, nursing facility, assisted living, or respite care.Rate this question:
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- 39.
Where is Good Cause verbiage that may be used when processing a good cause plan change request?
- A.
Toolkit
- B.
Heads Ups
- C.
Quick Access Guide
- D.
Training binder
Correct Answer
C. Quick Access GuideExplanation
The Quick Access Guide is where the Good Cause verbiage that may be used when processing a good cause plan change request can be found.Rate this question:
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- 40.
We need to place all escalated call notes in all caps to make sure the person reading the notes on the escalated call understands the importance of the issue. True or False?
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Escalated call notes do not need to be placed in all caps to convey the importance of the issue. The use of all caps can be seen as unprofessional and aggressive. Instead, the content of the notes should clearly and concisely explain the urgency and significance of the problem.Rate this question:
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.PNG "Why did the member receive the 'LTC Welcome-Non-Fully Eligible' letter?")
.PNG "What type of request is this?")
.PNG "What type of LTC enrollment request is this?")
.PNG "This complaint is in what status?")
.PNG "Does this recipient have Medicare coverage?")
.PNG "What MMA plan is this member currently enrolled in?")
.PNG "When was the active special condition last updated?")
.PNG "What ACWM does this recipient have?")
.PNG "This member is Excluded under MMA because...")
.PNG "What enrollment options does this member have?")
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Jul 31, 2023Quiz Edited by
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Dec 22, 2014Quiz Created by
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