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AHM-510 Exam Dumps : Governance and Regulation

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Governance and Regulation Questions and Answers

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Question 1

Health plans should monitor changes in the environment and emerging trends, because changes in society will affect the managed care industry. One true statement regarding recent changes in the environment in which health plans operate is that

Options:

A.

Women as a group receive more healthcare and interact more often with health plans than do men over the course of a lifetime

B.

The focus of healthcare during the past decade has shifted away from outpatient care to inpatient hospital treatment

C.

The uninsured population in the United States has been decreasing in recent years

D.

The decline in overall inflation in the 1990s failed to slow the growth in healthcare inflation

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Question 2

The Wentworth Corporation uses a self-funded plan to provide its employees with healthcare benefits. One consequence of Wentworth's approach to providing healthcare benefits is that self-funding

Options:

A.

Requires that Wentworth self-administer its healthcare benefit plan

B.

Requires that Wentworth pay higher state premium taxes than do insurers and health plans

C.

Eliminates the need for Wentworth to pay a risk charge to an insurer or health plan

D.

Increases the number of benefit and rating mandates that apply to Wentworth's plan

Question 3

One federal law amended the Social Security Act to allow states to set their own qualification standards for HMOs that contracted with state Medicaid programs and revised the requirement that participating HMOs have an enrollment mix of no more than 50% combined Medicare and Medicaid members.

This act, which was the true stimulus for increasing participation by health plans in Medicaid, is called the

Options:

A.

Omnibus Budget Reconciliation Act of 1981 (OBRA-81)

B.

Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA)

C.

Employee Retirement Income Security Act of 1974 (ERISA)

D.

Federal Employees Health Benefits Act of 1958 (FEHB Act)

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