Free AHM-540 Exam Braindumps

The following statements are about QAPI as it applies to Medicare+Choice plans and Medicaid health plan entities. Select the answer choice containing the correct statement.

1. A. QAPI provides separate sets of standards for Medicaid MCEs and Medicare+Choice plans.
2. B. Medicaid primary care case management (PCCM) programs are required to comply with all QAPI standards.
3. C. QISMC standards for quality measurement and improvement apply only to clinical services delivered to Medicare and Medicaid enrollees.
4. D. States that require Medicaid MCEs to comply with QAPI standards are considered to be in compliance with CMS quality assessment and improvement regulations.

Correct Answer: D

CMS has developed two prototype programs—Programs of All-inclusive Care for the Elderly (PACE) and the Social Health Maintenance Organization (SHMO) demonstration project—to deliver healthcare services to Medicare beneficiaries. From the answer choices below, select the response that correctly identifies the features of these programs.

1. A. PACE-annual limits on benefits for nursing home and community-based care SHMO-no limits on long-term care benefits
2. B. PACE-provide long-term care only SHMO-provide acute and long-term care
3. C. PACE-enrollees must be age 65 or older SHMO-enrollees must be age 55 or older
4. D. PACE-enrollment open to nursing home certifiable Medicare beneficiaries only SHMO- enrollment open to all Medicare beneficiaries

Correct Answer: D

Most health plans require a PCP referral or precertification for CAM benefits.

1. A. True
2. B. False

Correct Answer: B

The Strathmore Health Plan uses clinical pathways to manage its acute care services. In order to reduce the risk of financial liability associated with the use of clinical pathways, Strathmore and its network hospitals should

1. A. base pathways on relevant evidence reported in medical literature
2. B. restrict each pathway to a single medical condition
3. C. use pathways to establish a new standard of care
4. D. allow providers to use only those interventions listed in the pathways

Correct Answer: A

Designing effective medical management programs for Medicare beneficiaries requires an understanding of the unique health needs of the Medicare population. One characteristic of Medicare beneficiaries is that they typically

1. A. do not experience mental health problems
2. B. consume more than half of all prescription drugs
3. C. are likely to equate quality with the technical aspects of clinical procedures
4. D. require longer and more costly recovery periods following acute illnesses or injuries than does the general population

Correct Answer: D