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Question 48

The contract between the Honolulu MCO and Beverley Hills Hospital contains a 90 day cure provision. The Beverley Hills Hospital breached one of the contract requirements on July 31, 2004. The hospital remedied the problem by October 31, 2004. Which of the

Options:

The contract would not be terminated as Beverley Hills hospital rectified the problem within 90 days.

The contract would be terminated as Beverley Hills hospital was required to notify Honolulu MCO about the problem at least 90 days in advance.

The contract would be terminated as Beverley Hills hospital was required to rectify the problem within 90 days.

The contract would not be terminated as Beverley Hills hospital may escape adherence to the cure provision.

Question 49

One of the most influential pieces of legislation in the advancement of managed care within the United States was the HMO Act of 1973. One provision of the HMO Act of 1973 was that it

Options:

emphasized compensating physicians based solely on the volume of medical services they provide

exempted HMOs from all state licensure requirements

established a process under which HMOs could elect to be federally qualified

required federally qualified HMOs to relate premium levels to the health status of the individual enrollee or employer group

Question 50

Mr. George Bush is covered by a PBM plan that uses a closed formulary. This indicates that

Options:

he can receive coverage for pharmaceuticals only if they are on the PBM plan's preferred list of drugs

he must receive all of his pharmaceuticals from a mail-order pharmacy program

he can receive coverage for pharmaceuticals that are on the PBM plan's preferred list of drugs, as well as for pharmaceuticals that are not on the preferred list

the PBM plan cannot receive a rebate on any pharmaceuticals it obtains from the pharmaceutical facture

Question 51

One distinction that can be made between a staff model HMO and a group model HMO is that, in a staff model HMO, participating physicians are Back to Top