AHM-510最も有効な質問と解答で勉強

One provision of the Mental Health Parity Act of 1996 (MHPA) is that the MHPA prohibits group health plans from

• A. Imposing limits on the number of days or visits for mental health treatment
• B. Charging deductibles for mental health benefits that are higher than the deductibles for medical benefits
• C. Imposing annual limits on the number of outpatient visits and inpatient hospital stays for mental health services
• D. Setting a cap for a group member's lifetime medical health benefits that is higher than the cap for the member's lifetime mental health benefits

SoundCare Health Services, a health plan, recently conducted a situation analysis. One step in this analysis required SoundCare to examine its current activities, its strengths and weaknesses, and its ability to respond to potential threats and opportunities in the environment. This activity provided SoundCare with a realistic appraisal of its capabilities. One weakness that SoundCare identified during this process was that it lacked an effective program for preventing and detectingviolations of law. SoundCare decided to remedy this weakness by using the 1991 Federal Sentencing Guidelines for Organizations as a model for its compliance program.
By definition, the activity that SoundCare conducted when it examined its strengths, weaknesses, and capabilities is known as

• A. An environmental forecast
• B. An internal assessment
• C. A community analysis
• D. An environmental analysis

In the paragraph below, a statement contains two pairs of terms enclosed in parentheses. Determine which term in each pair correctly completes the statement. Then select the answer choice containing the two terms that you have chosen.
In the case of Pacificare of Oklahoma, Inc. v. Burrage, the U.S. Court of Appeals for the Tenth Circuit considered whether ERISA preempts medical malpractice claims against health plans based on certain liability theories. In this case, the Tenth Circuit court held that ERISA (should / should not) preempt a liability claim against an HMO for the malpractice of one of its primary care physicians, and therefore the HMO was subject to a claim of (subordinated / vicarious) liability.

• A. Should not / vicarious
• B. Should not / subordinated
• C. Should / vicarious
• D. Should / subordinated

The government uses various tools within the realm of two broad categories of public policy-allocative policies and regulatory policies. In the context of public policy, laws that fall into the category of allocative policy include

• A. The Balanced Budget Act (BBA) of 1997
• B. The Health Insurance Portability and Accountability Act (HIPAA) of 1996
• C. Laws specifying procedures for health plan handling of consumer appeals and grievances
• D. Laws affecting health plan quality oversight

The following statements appear in the Twilight Health Plan's strategic plan:
Increase the percentage of preventive health interventions for total eligible membership during each of the next three calendar years for the following services: mammography, Pap smears, immunizations, and first trimester visits for prenatal mothers
Improve customer satisfaction on an annual basis for each of the next three calendar years, as measured by satisfaction surveys for members, providers, and employer groups
Increase by 30% the number of claims processed by the automated claim payment system and reduce by 10% the cost of paying claims during the next three years
These statements are examples of Twilight's

• A. Company vision
• B. Company mission
• C. Corporate objectives
• D. Corporate strategies