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Governance and Regulation

Last Update 5 hours ago Total Questions : 76

The Governance and Regulation content is now fully updated, with all current exam questions added 5 hours ago. Deciding to include AHM-510 practice exam questions in your study plan goes far beyond basic test preparation.

You'll find that our AHM-510 exam questions frequently feature detailed scenarios and practical problem-solving exercises that directly mirror industry challenges. Engaging with these AHM-510 sample sets allows you to effectively manage your time and pace yourself, giving you the ability to finish any Governance and Regulation practice test comfortably within the allotted time.

Question # 1

In the paragraph below, a statement contains two pairs of terms enclosed in parentheses. Determine which term in each pair correctly completes the statement. Then select the answer choice containing the two terms that you have chosen.

One type of acquisition is called a stock purchase. In a typical stock purchase, a company acquires (51% / 100%) of the voting shares of another company's stock, thereby making the acquired company a subsidiary. The (acquired / acquiring) company holds all of the assets and liabilities of the acquired company.

A.

51% / acquired

B.

51% / acquiring

C.

100% / acquired

D.

100% / acquiring

Question # 2

The following statements describe various state benefit mandates. Select the answer choice that describes a state law pertaining to off-label uses for drugs.

A.

State A mandates that health plans provide benefits for experimental drugs for the treatment of terminal diseases such as AIDS and cancer.

B.

State B mandates that health plans have a procedure in place to allow a patient to have a non-formulary drug covered under certain conditions.

C.

State C mandates that, in dispensing generic drugs, pharmacies must label drug containers with the name of the substituted generic medication.

D.

State D mandates that health plans provide benefits for the treatment of one form of cancer with specific drugs that had originally been approved by the Food and Drug Administration (FDA) to treat other forms of cancer.

Question # 3

A federal law that significantly affects health plans is the Health Insurance Portability and Accountability Act of 1996 (HIPAA). In order to comply with HIPAA provisions, issuers offering group health coverage generally must.

A.

Renew group health policies in both small and large group markets, regardless of the health status of any group member

B.

Provide a plan member with a certificate of creditable coverage at the time the member enrolls in the group plan

C.

Both A and B

D.

A only

E.

B only

F.

Neither A nor B

Question # 4

The Opal Health Plan complies with all of the provisions of the Newborns' and Mothers' Health Protection Act of 1996 (NMHPA). Samantha Hill and Debra Chao are Opal enrollees. Ms. Hill was hospitalized for a cesarean birth, and Ms. Chao was hospitalized for a normal delivery. From the following answer choices, select the response that indicates the minimum hospital stay for which Opal, under NMHPA, must provide benefits for Ms. Hill and Ms. Chao.

A.

Ms. Hill: 72 hours; Ms. Chao: 24 hours

B.

Ms. Hill: 72 hours; Ms. Chao: 48 hours

C.

Ms. Hill: 96 hours; Ms. Chao: 24 hours

D.

Ms. Hill: 96 hours; Ms. Chao: 48 hours

Question # 5

Greenpath Health Services, Inc., an HMO, recently terminated some providers from its network in response to the changing enrollment and geographic needs of the plan. A provision in Greenpath's contracts with its healthcare providers states that Greenpath can terminate the contract at any time, without providing any reason for the termination, by giving the other party a specified period of notice.

The state in which Greenpath operates has an HMO statute that is patterned on the NAIC HMO Model Act, which requires Greenpath to notify enrollees of any material change in its provider network. As required by the HMO Model Act, the state insurance department is conducting an examination of Greenpath's operations. The scope of the on-site examination covers all aspects of Greenpath's market conduct operations, including its compliance with regulatory requirements.

The contracts between Greenpath and its healthcare providers contain a termination provision known as

A.

An 'economic credentialing' termination provision

B.

A 'breach of contract' termination provision

C.

A 'fair procedure' termination provision

D.

A 'without cause' termination provision

Question # 6

In the course of doing business, health plans conduct basic corporate transactions. For example, when a health plan engages in the corporate transaction known as aggressive sourcing, the health plan

A.

Chooses to contract with vendors who provide specific functions that would otherwise be performed in-house, such as paying claims

B.

Seeks to obtain the best deals from various vendors for equipment, supplies, and services such as telephones, overnight mail, computer hardware and software, and copy machines

C.

Merges with one or more companies to form an entirely new company

D.

Joins with one or more companies, but retains its autonomy and relies on the other companies to perform specific functions

Question # 7

There are several approaches to the interagency division of responsibility for managed care entity (MCE) oversight. In State M, the state Medicaid agency, the state department of health, and the state insurance department are all responsible for ensuring that quality improvement programs are in place among the same group of MCEs and that these programs meet each agency's rules and regulations for such programs. This information indicates that State M uses the approach known as the

A.

Parallel model

B.

Shared model

C.

Concurrent model

D.

PACE model

Question # 8

The Department of Health and Human Services (HHS) has delegated its responsibility for development and oversight of regulations under the Health Insurance Portability and Accountability Act (HIPAA) to an office within the Centers for Medicaid & Medicare Services (CMS). The CMS office that is responsible for enforcing the federal requirements of HIPAA is the

A.

Center for Health Plans and Providers (CHPPs)

B.

Center for Medicaid and State Operations

C.

Center for Beneficiary Services

D.

Center for Managed Care

Question # 9

One typical difference between a for-profit health plan's board of directors and a not-for-profit health plan's board of directors is that the directors in a for-profit health plan

A.

Can serve on the board for a period of no more than ten years, whereas the terms of service for a not-for-profit board's directors are usually unlimited by the director's age or by a preset maximum number of years of service

B.

Must participate in raising capital for the health plan, whereas a not-for-profit board's directors are prohibited from participating directly in raising capital for the health plan

C.

Are directly accountable to shareholders, whereas a not-for-profit board's directors are accountable to plan members and the community

D.

Are not compensated for board participation, whereas a not-for-profit board's directors are compensated for board participation

Question # 10

The National Association of Insurance Commissioners (NAIC) adopted the Health Maintenance Organization Model Act (HMO Model Act) to regulate the development and operations of HMOs. One true statement regarding the HMO Model Act is that the act

A.

includes mental health services in its definition of basic healthcare services

B.

authorizes only one state agency-the department of insurance-to regulate HMOs

C.

requires HMOs to place a deposit in trust with the state insurance commissioner for the purpose of protecting the interests of enrollees should an HMO become financially impaired

D.

requires HMOs that wish to offer a point-of-service (POS) product to contract with a licensed insurance company to provide POS options to plan members

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