AHIP Certification AHM-530 Syllabus Exam Questions Answers

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Question 24

The vision benefits offered by the Omni Health Plan include clinical eye care only. The following statements describe vision care received by Omni plan members:

• Brian Pollard received treatment for a torn retina he suffered as a result of an accident

• Angelica Herrera received a general eye examination to test her vision

• Megan Holtz received medical services for glaucoma

Of these medical services, the ones that most likely would be covered by Omni's vision coverage would be the services received by:

Options:

Mr. Pollard, Ms. Herrera, and Ms. Holtz

Mr. Pollard and Ms. Herrera only

Mr. Pollard and Ms. Holtz only

Ms. Herrera and Ms. Holtz only

Question 25

The Azure Health Plan strives to ensure for its plan members the best possible level of care from its providers. In order to maintain such high standards, Azure uses a variety of quantitative and qualitative (behavioral) measures to determine the effectiveness of its providers. Azure then compares the clinical and operational practices of its providers with those of other providers outside the network, with the goal of identifying and implementing the practices that lead to the best outcomes.

Qualitative measures that Azure could use to assess provider performance include an evaluation of how

Options:

Quickly the provider responds to plan members’ inquiries

Effectively the provider communicates with plan members

Often the provider refers plan members for ancillary services

Many plan members visit the provider per month

Question 26

One true statement about the Medicaid program in the United States is that:

Options:

The federal financial participation (FFP) in a state's Medicaid program ranges from 20% to 40% of the state's total Medicaid costs

Medicaid regulations mandate specific minimum benefits, under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program, for all Medicaid recipients younger than age 30

The individual states have responsibility for administering the Medicaid program

Non-disabled adults and children in low-income families account for the majority of direct Medicaid spending

Question 27

The Portway Hospital is qualified to receive Medicaid subsidy payments as a disproportionate share hospital (DHS). The DHS payments that Portway receives are