The Quality Assessment Performance Improvement (QAPI) is a quality initiative designed to strengthen health plans’ efforts to protect and improve the health and satisfaction of Medicare and Medicaid health plan enrollees. The Centers for Medicare and Medicaid Services (CMS) requires compliance with QAPI from

1. A. both Medicare+Choice plans and Medicaid health plans
2. B. Medicare+Choice plans only
3. C. Medicaid health plans only
4. D. neither Medicare+Choice plans nor Medicaid health plans

Correct Answer: B

Comorbidity can have a significant impact on the effective implementation of disease management programs. Comorbidity can correctly be defined as the

1. A. degree to which the progression of a disease or condition is understood
2. B. prevalence or rate of a sickness or injury within a given population
3. C. degree of severity of a particular disease or condition
4. D. presence of a chronic condition or added complication other than the condition that requires medical treatment

Correct Answer: D

Recent laws and regulations have established new requirements for Medicaid eligibility. The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 affected Medicaid eligibility by

1. A. severing the link between Medicaid and public assistance
2. B. eliminating the need for applications for Medicaid and public assistance
3. C. allowing states to provide healthcare benefits to groups outside the traditional Medicaid population
4. D. providing supplemental funding for dual eligibles in the form of five-year block grants

Correct Answer: A

The Fairview Health Plan uses a dual database approach to integrate information needed for its disease management program. This information indicates that Fairview uses an information management system that

1. A. combines all existing information from all data sources into a single comprehensive system
2. B. connects multiple databases with a central interface engine that acts as an information clearinghouse
3. C. provides an outside vendor with pertinent data that the vendor compiles into an integrated database
4. D. creates a separate database that pulls pertinent information from the health plan’s claims database, formats the information for easy analysis, and stores it in the separate database

Correct Answer: D

This agency has authority over Programs of All-inclusive Care for the Elderly (PACE) and the State Children’s Health Insurance Program (SCHIP).

1. A. Health Resources and Services Administration (HRSA)
2. B. Office of Personnel Management (OPM)
3. C. Department of Health and Human Services (HHS)
4. D. Department of Justice (DOJ)

Correct Answer: C