- (Topic 2)
Since 1981, states have had the option to experiment with new approaches to their Medicaid programs under the “freedom of choice” waivers. Under one such waiver, a Section 1915(b) waiver, states are allowed to

1. A. Give Medicaid recipients complete freedom in choosing healthcare providers
2. B. Give Medicaid recipients the option to choose not to enroll in a healthcare plan
3. C. Mandate certain categories of Medicaid recipients to enroll in health plans
4. D. Establish demonstration projects to test new approaches for delivering care to Medicaid recipients

Correct Answer: C

- (Topic 1)
From the following answer choices, choose the term that best matches the description.
An integrated delivery system (IDS), which controls most providers in a particular specialty, agrees to provide that specialty service to a health plan only on thecondition that the health planagree to contract with the IDS for other services.

1. A. Group boycott
2. B. Horizontal division of territories
3. C. Tying arrangements
4. D. Concerted refusal to admit

Correct Answer: C

- (Topic 1)
Lakesha Frazier, a member of a health plan in a rural area, had been experiencing heart palpitations and shortness of breath. Ms. Frazier’s primary care provider (PCP) referred her to a local hospital for an electrocardiogram. The results of the electrocardiogram were transmitted for diagnosis via high-speed data transmission to a heart specialist in a city 500 miles away. This information indicates that the results of Ms. Frazier’s electrocardiogram were transmitted using a communications system known as

1. A. Anarrow network
2. B. An integrated healthcare delivery system
3. C. Telemedicine
4. D. Customized networking

Correct Answer: C

- (Topic 1)
The Walton Health Plan uses the fee-for-service pharmaceutical reimbursement approach known as the maximum allowable cost (MAC) method. If Walton’s MAC list specifies a cost of 8 cents per tablet for a particular drug but the participating pharmacy pays 10 cents per tablet for the drug, then Walton will be obligated to reimburse the pharmacy for

1. A. 8 cents per tablet, but the pharmacy can bill the subscriber for the remaining 2 cents per tablet
2. B. 8 cents per tablet, and the pharmacy cannot bill the subscriber for the remaining 2 cents per tablet
3. C. 10 cents per tablet, but the pharmacy must refund the extra 2 cents per tablet to the subscriber
4. D. 10 cents per tablet, and the pharmacy is not required to refund the extra 2 cents per tablet to the subscriber

Correct Answer: B

- (Topic 1)
An health plan enters into a professional services capitation arrangement whenever the health plan

1. A. Contracts with a medical group, clinic, or multispecialty IPA that assumes responsibility for the costs of all physician services related to a patient’s care
2. B. Pays individual specialists to provide only radiology services to all plan members
3. C. Transfers all financial risk for healthcare services to a provider organization and the provider, in turn, covers virtually all of a patient’s medical expenses
4. D. Contracts with a primary care provider to cover primary care services only

Correct Answer: A